NPIMap

Organization Active NPI

Great Lakes Bay Orthodontics, PLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Midland, MI
National Provider Identifier
1336782135
Registry record updated Oct 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
GREAT LAKES BAY ORTHODONTICS, PLC
Practice address
200 Northgate Dr
Midland, MI 48640-7344
Phone
(989) 631-1334
NPI assigned
Oct 24, 2019
Last updated
Oct 24, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2019

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

Authorized official

Name
Andrew Grillo, DDS, MSDNPI 1013364736
Title
Orthodontist
Phone
(989) 600-8037

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X NU Primary

Addresses

Primary practice location

200 Northgate Dr
Midland, MI 48640-7344

Mailing address

200 Northgate Dr
Midland, MI 48640-7344
Phone (989) 631-1334

National Provider Directory

National Provider Directory

Locations

200 Northgate Dr
Midland, MI 48640
Phone (989) 631-1334

Practitioners & affiliated clinicians

Practitioners 3

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": "1571875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571875200000",
    "number": "1336782135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 NORTHGATE DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486407344",
            "telephone_number": "989-631-1334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 NORTHGATE DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486407344",
            "telephone_number": "989-631-1334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES BAY ORTHODONTICS, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-24",
        "last_updated": "2019-10-24",
        "status": "A",
        "authorized_official_last_name": "GRILLO",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "ORTHODONTIST",
        "authorized_official_telephone_number": "989-600-8037",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, MI

Sources for this page

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