Great Lakes Family Dental Group-Lansing, P.C.

Primary specialty

DentistTaxonomy code 122300000X

License

12257 Issued in MI

Legal business name

GREAT LAKES FAMILY DENTAL GROUP-LANSING, P.C.

Practice address

3515 Coolidge Road
Suite C
East Lansing, MI 48823

Phone

(517) 332-2422

NPI assigned

Dec 9, 2013

Last updated

Feb 8, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. C. Patrick Gray, D.D.S.

Title

Owner

Phone

(810) 732-0200

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1386547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486512000000",
    "number": "1366873937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3515 COOLIDGE RD",
            "address_2": "SUITE C",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488238014",
            "telephone_number": "810-230-3245",
            "fax_number": "810-230-3229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3515 COOLIDGE ROAD",
            "address_2": "SUITE C",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "48823",
            "telephone_number": "517-332-2422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES FAMILY DENTAL GROUP-LANSING, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-09",
        "last_updated": "2017-02-08",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "C.",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-732-0200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "12257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "PTAN7290590001",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2017; 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.