Crescent Lake Dental Care PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CRESCENT LAKE DENTAL CARE PLLC

Practice address

998 Crescent Lake Rd
Waterford, MI 48327-2594

Phone

(248) 682-9331

NPI assigned

Feb 26, 2024

Organization subpart

No

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

Authorized official

Name

Mohammed Sobh, DDSNPI 1962062125

Title

Owner/Doctor

Phone

(313) 663-6484

Specialties & licenses 1

Addresses

Practitioners 2

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

• Mohammed Sobh, DDS

  • General Practice Dentistry
  • Dearborn, MI
  • NPI 1962062125
  NPD (past) Authorized official
• Glen Joseph Marsack, D.D.S.

  • General Practice Dentistry
  • Waterford, MI
  • NPI 1386792828
  NPD (past)

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

{
    "created_epoch": "1708905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1124884366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1849 N DENWOOD ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481281156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "998 CRESCENT LAKE RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483272594",
            "telephone_number": "248-682-9331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT LAKE DENTAL CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-26",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "SOBH",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "313-663-6484",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chavicha Cowans, LLMSW
• Amber Cox
• Samuel Craig, PHD
• Jessica Mara Crawford, LPC
• Carrie Creech
• Rachael Crise, DO
• Debra I Cronin, LMT
• Sarah Cummings, CPNP
• John Renouard Cushing Jr., DDS
• Sherri N Dale

• All providers in Waterford, MI
• Dental Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; 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.