Access Dental Group PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

014902 Issued in MI

Legal business name

ACCESS DENTAL GROUP PLLC

Practice address

431 Munson Ave Ste C
Traverse City, MI 49686-3060

Phone

(231) 935-8461

Fax

(231) 935-8467

NPI assigned

Sep 8, 2006

Organization subpart

No

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

Authorized official

Name

Amanda Hagie

Title

Office Manager

Phone

(231) 935-8461

Specialties & licenses 3

Addresses

Other identifiers 3

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.

• Kerry M Kaysserian, DDS

  • General Practice Dentistry
  • Traverse City, MI
  • NPI 1528162872
  NPD (past)
• Rob R Lovell, DDS

  • General Practice Dentistry
  • Traverse City, MI
  • NPI 1457455701
  NPD (past)

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672272000000",
    "number": "1093819344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "431 MUNSON AVE STE C",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863060",
            "telephone_number": "231-935-8461",
            "fax_number": "231-935-8467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 MUNSON AVE STE C",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863060",
            "telephone_number": "231-935-8461",
            "fax_number": "231-935-8467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCESS DENTAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-08",
        "last_updated": "2022-12-29",
        "certification_date": "2022-12-29",
        "status": "A",
        "authorized_official_last_name": "HAGIE",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "231-935-8461"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "012813",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "012865",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "014902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MS",
            "identifier": "D80295",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "823434",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI",
            "identifier": "D802395",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Traverse City, MI
• Providers in Traverse City, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2022; 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.