Gratiot Dental PC

Primary specialty

DentistTaxonomy code 122300000X

License

12881 Issued in MI

Legal business name

GRATIOT DENTAL PC

Practice address

12645 Gratiot Ave
Detroit, MI 48205-3952

Phone

(313) 527-1140

Fax

(313) 527-9022

NPI assigned

Oct 22, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Wallace Lee Walker, DDS

Title

President

Phone

(313) 527-1140

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Diane Ingram Hines, D.D.S.

  • General Practice Dentistry
  • Detroit, MI
  • NPI 1255418471
  NPD (past)
• Wayne Veal, D.D.S.

  • Dentist
  • Detroit, MI
  • NPI 1659535722
  NPD (past)

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

{
    "created_epoch": "1193011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193011200000",
    "number": "1073702478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12645 GRATIOT AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482053952",
            "telephone_number": "313-527-1140",
            "fax_number": "313-527-9022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12645 GRATIOT AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482053952",
            "telephone_number": "313-527-1140",
            "fax_number": "313-527-9022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRATIOT DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-22",
        "last_updated": "2007-10-22",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-527-1140",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "12881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grate Drawmoblie Lab LLC
• Desiree Ann Grate
• Grateful Hearts Homecare
• Gratiot Advanced Center LLC
• Gratiot Clinic
• Gratiot Drug Store Inc (Gratiot Pharmacy)
• Gratiot New Pharmacy
• Gratiot Seven Pharmacy, LLC (PharMor Pharmacy - Gratiot)
• Gratitude House
• Victoria Ivy Grattan, LLPC

• Dentist in Detroit, MI
• Providers in Detroit, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; 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.