Great Lakes Dental Group PLLC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

GREAT LAKES DENTAL GROUP PLLC

Practice address

4251 Coolidge Hwy
Royal Oak, MI 48073-1639

Phone

(248) 547-3700

NPI assigned

Sep 19, 2023

Organization subpart

No

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

Authorized official

Name

Delia Danowski

Title

Office Manager

Phone

(248) 547-3700

Specialties & licenses 3

Addresses

Other names 1

• Dental Implant Center of Royal Oak Doing business as

Locations

Practitioners 2

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

• Omar E Elbanhawy, DDS, MS

  • Periodontics
  • Grosse Pointe, MI
  • NPI 1780994533
  NPD
• Chady Ahmed Elhage, D.D.S., M.S.

  • Prosthodontics
  • Royal Oak, MI
  • NPI 1588957799
  NPD

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

{
    "created_epoch": "1695081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695081600000",
    "number": "1053199141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4251 COOLIDGE HWY",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480731639",
            "telephone_number": "248-547-3700",
            "fax_number": "248-547-2297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4251 COOLIDGE HWY",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480731639",
            "telephone_number": "248-547-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES DENTAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-19",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A",
        "authorized_official_last_name": "DANOWSKI",
        "authorized_official_first_name": "DELIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "248-547-3700"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Implant Center of Royal Oak",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Giovi Nmi Grasso Knight, MD
• Michael Gratson, M.D.
• Erika Jane Gray, PT
• Latasha Danielle Gray
• Pamela Sue Gray, N.P.
• Christopher Miles Green, MA, LLP
• Emily Green
• Teresa Ann Green, MSW, CSW
• Greenberger Wu Dunn & Fields, PLLC
• Marc J Greenberger, M.D.

• Periodontics in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Periodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2023; 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.