OrganizationActive
Southfield Dental PLLC
NPI 1104067644 · Dentist · Southfield, MI
Southfield Dental PLLC is a Dentist organization in Southfield, MI (NPI 1104067644).
Provider details
- NPI number
- 1104067644
- Entity type
- Organization
- Primary specialty
- DentistDental Providers
- Organization subpart
- No
- Authorized official
- Raymond Fortson, Member(248) 569-6722
- License
- 2901014077 (MI)
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(86/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
17 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
17600 W 12 Mile Rd
Suite 3
Southfield, MI 48076-1910
Phone: (248) 569-6722
Fax: (248) 569-7409
Street-level locationGet directions
Mailing address
17600 W 12 Mile Rd
Southfield, MI 48076-1910
Registry dates
- Enumerated
- 2009-03-12
- Last updated
- 2009-03-12
Frequently asked questions
- What is Southfield Dental PLLC's NPI number?
- Southfield Dental PLLC's National Provider Identifier (NPI) is 1104067644, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Southfield Dental PLLC?
- Southfield Dental PLLC is classified in the NPPES registry as Dentist (Dental Providers).
- Where is Southfield Dental PLLC located?
- Southfield Dental PLLC's practice location on file with NPPES is 17600 W 12 Mile Rd, Southfield, MI 48076-1910.
- What is Southfield Dental PLLC's phone number?
- The practice phone number listed in the NPPES registry for Southfield Dental PLLC is (248) 569-6722.
- Who is the authorized official for Southfield Dental PLLC?
- The authorized official listed on Southfield Dental PLLC's NPPES record is Raymond Fortson, Member. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Southfield Dental PLLC's NPI active?
- Yes — Southfield Dental PLLC's NPI (1104067644) is active in the NPPES registry as of the last update on 2009-03-12.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.