Jewell Lake Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

License

2901015703 Issued in MI

Legal business name

JEWELL LAKE DENTAL LLC

Practice address

1889 W Trask Lake Rd
Barton City, MI 48705

Phone

(989) 736-7000

NPI assigned

Jun 24, 2010

Last updated

Jun 24, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Steven Rodriguez, DDS

Title

Owner

Phone

(989) 736-7000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1277337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277337600000",
    "number": "1114238151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1889 W TRASK LAKE RD",
            "address_2": "PO BOX 193",
            "city": "BARTON CITY",
            "state": "MI",
            "postal_code": "48705",
            "telephone_number": "989-736-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1889 W TRASK LAKE RD",
            "city": "BARTON CITY",
            "state": "MI",
            "postal_code": "48705",
            "telephone_number": "989-736-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEWELL LAKE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-24",
        "last_updated": "2010-06-24",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-736-7000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901015703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2010; 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.