Grass Lake Dental Center PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

GRASS LAKE DENTAL CENTER PLLC

Practice address

11745 E Michigan Ave
Grass Lake, MI 49240-9219

Phone

(517) 522-5018

NPI assigned

Apr 27, 2022

Last updated

Apr 27, 2022By 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

Mrs. Luciana Gabriela Castro, DDSNPI 1710367636

Title

Owner

Phone

(734) 355-0779

Specialties & licenses 1

Addresses

Practitioners 2

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.

• Luciana Castro

  • General Practice Dentistry
  • Grass Lake, MI
  • NPI 1710367636
  NPD Authorized official
• Sally A. Stommen, D.D.S.

  • General Practice Dentistry
  • Grass Lake, MI
  • NPI 1871566612
  NPD (past)

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

{
    "created_epoch": "1651017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651017600000",
    "number": "1386388114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2143 ORCHARDVIEW",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481082766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11745 E MICHIGAN AVE",
            "city": "GRASS LAKE",
            "state": "MI",
            "postal_code": "492409219",
            "telephone_number": "517-522-5018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRASS LAKE DENTAL CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-27",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-20",
        "status": "A",
        "authorized_official_last_name": "CASTRO",
        "authorized_official_first_name": "LUCIANA",
        "authorized_official_middle_name": "GABRIELA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-355-0779",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick Raymond Eckes, DC
• Deana Fisher
• David Oneill Foley
• Holly Elizabeth Gist-Richer, LMSW
• Grass Lake Chiropractic Center, PLLC
• Grass Lake Surgery Center LLC
• Venus Hagar
• Lori A Healy, MA, LLP, CAADC
• Aydrianne Elizabeth Hofschild, MT-BC
• Madison Holcomb, R.N.

• Dental Clinic/Center in Grass Lake, MI
• Providers in Grass Lake, 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 Apr 27, 2022; 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.