Crestwood Dental on the Lake, PLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CRESTWOOD DENTAL ON THE LAKE, PLC

Practice address

1363 Rochester Rd
Leonard, MI 48367-6607

Phone

(248) 800-4140

NPI assigned

Dec 21, 2021

Organization subpart

No

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

Authorized official

Name

Dr. John J Abdelmessih, DDS

Title

Owner

Phone

(248) 800-4140

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1640044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1306506100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1363 ROCHESTER RD",
            "city": "LEONARD",
            "state": "MI",
            "postal_code": "483676607",
            "telephone_number": "248-800-4140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1363 ROCHESTER RD",
            "city": "LEONARD",
            "state": "MI",
            "postal_code": "483676607",
            "telephone_number": "248-800-4140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWOOD DENTAL ON THE LAKE, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-21",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A",
        "authorized_official_last_name": "ABDELMESSIH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-800-4140",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Biehl
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• Kelli Nicole Fogarty, RN
• Robert J Kanas, DDS
• Colleen M Klosterman, O.T.R.
• Amanda Partain
• Pamela Mary Phillips, MA, LLPC, NCC, SCL

• Dental Clinic/Center in Leonard, MI
• Providers in Leonard, MI by specialty
• Dental Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; 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.