East Lake Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

EAST LAKE DENTAL PLLC

Practice address

201 S Lafayette St
South Lyon, MI 48178-1405

Phone

(248) 437-4119

NPI assigned

Mar 16, 2021

Organization subpart

No

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

Authorized official

Name

William Ryan Jenkins, DDSNPI 1619327673

Title

Owner Dentist

Phone

(248) 321-9485

Specialties & licenses 1

Addresses

Practitioners 1

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

• William Ryan Jenkins, D.D.S.

  • General Practice Dentistry
  • South Lyon, MI
  • NPI 1619327673
  NPD (past) Authorized official

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

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615852800000",
    "number": "1104401645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3542 OAKSHIRE AVE",
            "city": "BERKLEY",
            "state": "MI",
            "postal_code": "480723411",
            "telephone_number": "248-321-9485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S LAFAYETTE ST",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481781405",
            "telephone_number": "248-437-4119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST LAKE DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-16",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-12",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "248-321-9485",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in South Lyon, MI
• Providers in South Lyon, 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 Mar 16, 2021; 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.