Great Lakes Dental, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

4018 Issued in WI

Legal business name

GREAT LAKES DENTAL, LLC

Practice address

W188N11927 Maple Rd
Suite 12
Germantown, WI 53022-6328

Phone

(262) 509-5755

Fax

(262) 565-2420

NPI assigned

Feb 9, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Robert J Grzybowski, DDS

Title

Owner

Phone

(262) 509-5755

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1328745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328745600000",
    "number": "1043582869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W188N11927 MAPLE RD",
            "address_2": "SUITE 12",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530226328",
            "telephone_number": "262-509-5755",
            "fax_number": "262-565-2420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W188N11927 MAPLE RD",
            "address_2": "SUITE 12",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530226328",
            "telephone_number": "262-509-5755",
            "fax_number": "262-565-2420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-09",
        "last_updated": "2012-02-09",
        "status": "A",
        "authorized_official_last_name": "GRZYBOWSKI",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-509-5755",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "4018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chandler Gloudeman
• Laura L Goba, APSW
• Brandon Goesch
• Timothy F Goggins, M.D.
• Patricia Ann Gottsacker, P.T., C.PED.
• Great Lakes Healthcare, Inc.
• Great Lakes Healthcare, Inc.
• Great Lakes Healthcare, Inc.
• Kaitlin Rose Grigoryev
• Marisa Groshek, DPT

• Dentist in Germantown, WI
• Providers in Germantown, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2012; 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.