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 is a Dentist 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
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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