Aspen Dental of Michigan PC

Key facts

NPI

1285813832

Entity type

Organization (NPI type 2)

Primary specialty

General Practice Dentistry 1223G0001X

License

2901019539 (MI)

Legal business name

ASPEN DENTAL OF MICHIGAN PC

Practice address

4391 Canal Ave SW
Grandville, MI 49418-2680

Phone

(616) 530-3900

NPI assigned

Oct 31, 2007

Organization subpart

No

Authorized official

Name

Isam Hamati

Title

Owner

Phone

(315) 454-6000

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 31, 2007.

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193788800000",
    "number": "1285813832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "281 SANDERS CREEK PKWY",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130571307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4391 CANAL AVE SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182680",
            "telephone_number": "616-530-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASPEN DENTAL OF MICHIGAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-31",
        "last_updated": "2007-10-31",
        "status": "A",
        "authorized_official_last_name": "HAMATI",
        "authorized_official_first_name": "ISAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-454-6000"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901019539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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