Harborside Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

HARBORSIDE DENTAL PLLC

Practice address

13300 S West Bay Shore Dr Ste 1
Traverse City, MI 49684-5571

Phone

(231) 946-0207

NPI assigned

Nov 26, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Mark David Krull, DDSNPI 1902397425

Title

Partner

Phone

(231) 946-0207

Specialties & licenses 1

Addresses

Other names 1

• Harborside Dental Doing business as

Locations

Practitioners 3

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

• Mark David Krull, DDS

  • General Practice Dentistry
  • Traverse City, MI
  • NPI 1902397425
  NPD Authorized official
• Stephen E Kozelko Jr., DDS

  • General Practice Dentistry
  • Traverse City, MI
  • NPI 1255381893
  NPD (past)
• Frank C Rugani, DDS

  • General Practice Dentistry
  • Traverse City, MI
  • NPI 1013966522
  NPD (past)

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

{
    "created_epoch": "1574726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574726400000",
    "number": "1114563012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13300 S WEST BAY SHORE DR STE 1",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496845571",
            "telephone_number": "231-946-0207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13300 S WEST BAY SHORE DR STE 1",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496845571",
            "telephone_number": "231-946-0207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBORSIDE DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-26",
        "last_updated": "2019-11-26",
        "status": "A",
        "authorized_official_last_name": "KRULL",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "231-946-0207",
        "authorized_official_name_prefix": "Dr.",
        "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": [
        {
            "organization_name": "Harborside Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kymbra R. Hansen-Duell, LMSW
• Amber Michele Hansen
• Ashley Denise Hansen, PT
• Harbor Care Associates, LLC
• Harbor Oxygen of Traverse City, LLC
• Bobbi Marie Harding, LMSW-C
• Brittney Michelle Harding
• Thomas Robert Harding, MD
• Harm Reduction Michigan
• Laura Lynn Harman

• 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 Nov 26, 2019; 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.