NPIMap

Organization Active NPI

Great Lakes Family Dental Group Dexter, PC

  • General Practice Dentistry
  • Dexter, MI
National Provider Identifier
1003191941
Registry record updated Oct 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
GREAT LAKES FAMILY DENTAL GROUP DEXTER, PC
Practice address
3060 Baker Rd
Dexter, MI 48130-1140
Phone
(734) 426-4651
NPI assigned
Oct 11, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Patricia J. Hart
Title
Corporate Manager
Phone
(810) 625-2860

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

3060 Baker Rd
Dexter, MI 48130-1140

Mailing address

3060 Baker Rd
Dexter, MI 48130-1140
Phone (734) 426-4651

National Provider Directory

National Provider Directory

Locations

3060 Baker Rd
Dexter, MI 48130
Phone (734) 426-4651

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318291200000",
    "number": "1003191941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3060 BAKER RD",
            "city": "DEXTER",
            "state": "MI",
            "postal_code": "481301140",
            "telephone_number": "734-426-4651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3060 BAKER RD",
            "city": "DEXTER",
            "state": "MI",
            "postal_code": "481301140",
            "telephone_number": "734-426-4651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES FAMILY DENTAL GROUP DEXTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-11",
        "last_updated": "2011-10-11",
        "status": "A",
        "authorized_official_last_name": "HART",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CORPORATE MANAGER",
        "authorized_official_telephone_number": "810-625-2860"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dexter, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.