NPIMap

Organization Active NPI

Lakshore Family Dental

  • Dentist
  • Stevensville, MI
National Provider Identifier
1356614838
Registry record updated Feb 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901019195 Issued in MI
Legal business name
LAKSHORE FAMILY DENTAL
Practice address
5638 Cleveland Ave
Stevensville, MI 49127-9696
Phone
(269) 429-4661
Fax
(269) 429-4486
NPI assigned
Feb 15, 2012
Last updated
Feb 15, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2012

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

Authorized official

Name
Dr. Andrew BargrenNPI 1568593655
Title
Owner
Phone
(269) 429-4661

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 2901019195 MI Primary

Addresses

Primary practice location

5638 Cleveland Ave
Stevensville, MI 49127-9696

Mailing address

5638 Cleveland Ave
Stevensville, MI 49127-9696
Phone (269) 429-4661

National Provider Directory

National Provider Directory

Locations

5638 Cleveland Ave
Stevensville, MI 49127
Phone (269) 429-4661

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": "1329264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329264000000",
    "number": "1356614838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5638 CLEVELAND AVE",
            "city": "STEVENSVILLE",
            "state": "MI",
            "postal_code": "491279696",
            "telephone_number": "269-429-4661",
            "fax_number": "269-429-4486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5638 CLEVELAND AVE",
            "city": "STEVENSVILLE",
            "state": "MI",
            "postal_code": "491279696",
            "telephone_number": "269-429-4661",
            "fax_number": "269-429-4486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKSHORE FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-15",
        "last_updated": "2012-02-15",
        "status": "A",
        "authorized_official_last_name": "BARGREN",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-429-4661",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901019195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stevensville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.