TLC Dental of Walled Lake, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

17214 Issued in MI

Legal business name

TLC DENTAL OF WALLED LAKE, PLLC

Practice address

1264 S Commerce Rd
Walled Lake, MI 48390-3008

Phone

(248) 624-4774

Fax

(248) 624-9256

NPI assigned

Sep 21, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Kurt Heuerman, DDS

Title

Owner

Phone

(248) 624-4774

Specialties & licenses 3

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.

• Khaldoun M Tarabin, DDS

  • General Practice Dentistry
  • Walled Lake, MI
  • NPI 1881720548
  NPD (past)

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104925775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1264 S COMMERCE RD",
            "city": "WALLED LAKE",
            "state": "MI",
            "postal_code": "483903008",
            "telephone_number": "248-624-4774",
            "fax_number": "248-624-9256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1264 S COMMERCE RD",
            "city": "WALLED LAKE",
            "state": "MI",
            "postal_code": "483903008",
            "telephone_number": "248-624-4774",
            "fax_number": "248-624-9256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TLC DENTAL OF WALLED LAKE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HEUERMAN",
        "authorized_official_first_name": "KURT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-624-4774",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "18099",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901018746",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "17214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DDS",
            "identifier": "17087",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Walled Lake, MI
• Providers in Walled Lake, 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 Aug 22, 2020; 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.