NPIMap

Organization Active NPI

Grand Lake Family Dentistry Travis D Lutz DDS- Rockford LTD

  • General Practice Dentistry
  • Rockford, OH
National Provider Identifier
1366044158
Registry record updated Nov 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
GRAND LAKE FAMILY DENTISTRY TRAVIS D LUTZ DDS- ROCKFORD LTD
Practice address
160 E. Walnut St.
Rockford, OH 45882
Phone
(419) 363-3537
NPI assigned
Nov 16, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2020

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

Authorized official

Name
Dr. Travis Lutz, DDS
Title
Owner/Dentist
Phone
(419) 305-9983

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

160 E. Walnut St.
Rockford, OH 45882

Mailing address

160 E. Walnut St.
Rockford, OH 45882
Phone (419) 363-3537

National Provider Directory

National Provider Directory

Locations

160 E Walnut St
Rockford, OH 45882
Phone (419) 363-3537

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1605484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605484800000",
    "number": "1366044158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 E. WALNUT ST.",
            "city": "ROCKFORD",
            "state": "OH",
            "postal_code": "45882",
            "telephone_number": "419-363-3537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 E. WALNUT ST.",
            "city": "ROCKFORD",
            "state": "OH",
            "postal_code": "45882",
            "telephone_number": "419-363-3537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND LAKE FAMILY DENTISTRY TRAVIS D LUTZ DDS- ROCKFORD LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-16",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-12",
        "status": "A",
        "authorized_official_last_name": "LUTZ",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "419-305-9983",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; 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.