NPIMap

Organization Active NPI

Grand Traverse Band of Ottawa and Chippewa Indians

  • Dental Clinic/Center
  • Peshawbestown, MI
National Provider Identifier
1508126517
Registry record updated Dec 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
261QD0000X Issued in MI
Legal business name
GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS
Practice address
2300 N Stallman Road
Peshawbestown, MI 49682
Phone
(231) 534-7211
Fax
(231) 534-7460
NPI assigned
May 23, 2012
Last updated
Dec 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2013

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

Authorized official

Name
Ms. Lori E Chambers
Title
Manager
Phone
(231) 534-7477

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 261QD0000X MI Primary

Addresses

Primary practice location

2300 N Stallman Road
Peshawbestown, MI 49682

Mailing address

2300 N Stallman Road
Suite a
Peshawbestown, MI 49682
Phone (231) 534-7211

Other names 1

  • GTB Dental Clinc Other name

National Provider Directory

National Provider Directory
Tax ID family
Grand Traverse Band Hea3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1337731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386115200000",
    "number": "1508126517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 N STALLMAN ROAD",
            "address_2": "SUITE A",
            "city": "PESHAWBESTOWN",
            "state": "MI",
            "postal_code": "49682",
            "telephone_number": "231-534-7211",
            "fax_number": "231-534-7460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 N STALLMAN ROAD",
            "city": "PESHAWBESTOWN",
            "state": "MI",
            "postal_code": "49682",
            "telephone_number": "231-534-7211",
            "fax_number": "231-534-7460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-23",
        "last_updated": "2013-12-04",
        "status": "A",
        "authorized_official_last_name": "CHAMBERS",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "231-534-7477",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MI",
            "license": "261QD0000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GTB Dental Clinc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Peshawbestown, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2013; 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.