DIVERSIFIED DENTAL, P.C.
NPI 1669191342
Clinic/Center - Dental in Saint Clair Shores, MI

Q: What is Diversified Dental, P.C.'s NPI number?

The NPI number for Diversified Dental, P.C. is 1669191342. It was assigned to this organization in the NPPES registry on August 25, 2022.

Q: What is Diversified Dental, P.C.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Dental, with taxonomy code 261QD0000X.

Active since August 25, 2022

30231 JEFFERSON AVE, SAINT CLAIR SHORES, MI 48082(586) 775-2400 Get Directions Write a Review

NPPES record last updated: August 25, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Diversified Dental, P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DIVERSIFIED DENTAL, P.C. (NPI 1669191342) is a healthcare organization registered as a dental in Saint Clair Shores, Michigan and active in the NPI registry since August 2022. The organization lists Kevin D Prush, Dentist, as its authorized official.

NPPES Registry Identity

NPI1669191342

Entity TypeOrganization

Primary Taxonomy261QD0000X

Legal Business NameDIVERSIFIED DENTAL, P.C.

Location Address30231 JEFFERSON AVESaint Clair Shores, MI 48082-1787

Mailing Address30231 Jefferson AveSaint Clair Shores, MI 48082-1787

Phone(586) 775-2400

Organization SubpartNo

Authorized OfficialKevin D PrushDentist · (586) 775-2400

Enumeration DateAugust 25, 2022

NPPES CertifiedAugust 25, 2022

✔ NPI 1669191342 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · DentalAmbulatory Health Care Facilities

Taxonomy Code261QD0000X

30231 JEFFERSON AVE, Saint Clair Shores, MI 48082

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Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DAVID MAURICE SORBO D.D.S.

Dentist (General Practice)

30231 JEFFERSON AVE
SAINT CLAIR SHORES, MI 48082

Macomb County (586) 294-0350

DR. KEVIN DONALD PRUSH DDS

Dentist (General Practice)

30231 JEFFERSON AVE
SAINT CLAIR SHORES, MI 48082

Macomb County (586) 775-2400

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Diversified Dental, P.C.'s NPI number?

The NPI number for Diversified Dental, P.C. is 1669191342. It was assigned to this organization in the NPPES registry on August 25, 2022.

Where is Diversified Dental, P.C. located?

Diversified Dental, P.C. is located at 30231 Jefferson Ave, Saint Clair Shores, MI 48082. The listed phone number is (586) 775-2400.

What is Diversified Dental, P.C.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Dental, with taxonomy code 261QD0000X.

When was this NPI record last updated?

The NPPES record for Diversified Dental, P.C. was last updated on August 25, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.