Unknown Individual – Oral and Maxillofacial Surgery (Dentist), NPI 1366442212

Unknown Individual is a healthcare provider. based in Warren, Michigan. specializing in Oral and Maxillofacial Surgery (Dentist). They hold a License No. 2901009207 (MI). The NPI Number for Unknown Individual is 1366442212

Main info

Organization
Inactive
59 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1366442212
Phone
(586) 755-2770
Address
25916 DEQUINDRE RD
Deactivation Date
2 August 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1967 (59 years ago)
PAC ID
6002707148
Professional Enrollment ID
I20050801000060
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Dequindre Road, Warren, Macomb County, Michigan, 48901, United States

    WARREN, MI 480916112

    Phone: (586) 755-2770

    Fax: (586) 755-1690

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 48091)

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Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?
The NPI 1366442212 uniquely identifies Unknown Individual in U.S. healthcare data.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
How should patients interpret Unknown Individual's specialty?
The extract shows Oral and Maxillofacial Surgery (Dentist) for Unknown Individual. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Warren, Michigan. Check all listed addresses for suites or satellite offices.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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