NPIMap

Organization Active NPI

Bright Side Dental-St. Clair Shores PLLC

  • General Practice Dentistry
  • Saint Clair Shores, MI
National Provider Identifier
1235497595
Registry record updated Apr 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901018970 Issued in MI
Legal business name
BRIGHT SIDE DENTAL-ST. CLAIR SHORES PLLC
Practice address
31245 Harper Ave
Saint Clair Shores, MI 48082-1401
Phone
(586) 439-2940
NPI assigned
Apr 24, 2012
Last updated
Apr 24, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2012

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

Authorized official

Name
Dr. Derek Grytzelius, D.D.S.
Title
Owner/Doctor
Phone
(586) 439-2940

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901018970 MI Primary

Addresses

Primary practice location

31245 Harper Ave
Saint Clair Shores, MI 48082-1401

Mailing address

31245 Harper Ave
Saint Clair Shores, MI 48082-1401
Phone (586) 439-2940

National Provider Directory

National Provider Directory

Locations

31245 Harper Ave
Saint Clair Shores, MI 48082
Phone (586) 439-2940

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1335225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335225600000",
    "number": "1235497595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31245 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480821401",
            "telephone_number": "586-439-2940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31245 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480821401",
            "telephone_number": "586-439-2940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGHT SIDE DENTAL-ST. CLAIR SHORES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-24",
        "last_updated": "2012-04-24",
        "status": "A",
        "authorized_official_last_name": "GRYTZELIUS",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "586-439-2940",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901018970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2012; 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.