Park View Family Dentistry

Primary specialty

DentistTaxonomy code 122300000X

License

22901019425 Issued in MI

Legal business name

PARK VIEW FAMILY DENTISTRY

Practice address

202 N Lake St
Boyne City, MI 49712-1210

Phone

(231) 582-4480

Fax

(231) 582-4460

NPI assigned

Nov 25, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Jennifer Sue Larson, DDSNPI 1629156500

Title

President / Owner

Phone

(231) 350-6747

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Jennifer Sue Larson, DDS

  • Dentist
  • Boyne City, MI
  • NPI 1629156500
  NPD Authorized official

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

{
    "created_epoch": "1385337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385337600000",
    "number": "1104256387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 N LAKE ST",
            "city": "BOYNE CITY",
            "state": "MI",
            "postal_code": "497121210",
            "telephone_number": "231-582-4480",
            "fax_number": "231-582-4460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 N LAKE ST",
            "city": "BOYNE CITY",
            "state": "MI",
            "postal_code": "497121210",
            "telephone_number": "231-582-4480",
            "fax_number": "231-582-4460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK VIEW FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-25",
        "last_updated": "2013-11-25",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "PRESIDENT / OWNER",
        "authorized_official_telephone_number": "231-350-6747",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "22901019425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE DENTAL LICENSE",
            "identifier": "2901019425",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gabriel Denzel Paulsen, PHARMD
• Alisha Peck-Muma, LMSW
• Ricky Lynn Pethers, DC
• Teresa Potter

• Dentist in Boyne City, MI
• Providers in Boyne City, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2013; 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.