Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Southfield Dental PLLC

Organization Dentist · NPI 1104067644

Southfield Dental PLLC provides Dentist services in Southfield, Michigan. Licensed in Michigan. Registered with an NPI since 2009.

Licensed in
MI
In the registry since
2009
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

17600 W 12 Mile Rd Ste 3
Southfield, MI 48076-1910 Not confirmed with CMS for 17 years — call before visiting
Phone: (248) 569-6722
Fax: (248) 569-7409
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 2901014077 (MI)

Record details

NPI number1104067644
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Raymond Fortson — Member · (248) 569-6722
NPI enumeratedMarch 12, 2009
Last updated in NPPESMarch 12, 2009
Mailing address17600 W 12 Mile Rd, Suite 3, Southfield, MI 48076-1910

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