Square Lake Family Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901015961 Issued in MI

Legal business name

SQUARE LAKE FAMILY DENTISTRY

Practice address

6053 Rochester Rd
Troy, MI 48085-1303

Phone

(248) 879-5858

Fax

(248) 879-3578

NPI assigned

Oct 18, 2006

Last updated

Jan 31, 2008By 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. Pritida Tushar Patel, DDSNPI 1508022419

Title

Secretary

Phone

(248) 879-5858

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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.

• Pritida T Patel, DDS

  • General Practice Dentistry
  • Troy, MI
  • NPI 1508022419
  Authorized official Same address or phone

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201737600000",
    "number": "1558442202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6053 ROCHESTER RD",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480851303",
            "telephone_number": "248-879-5858",
            "fax_number": "248-879-3578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6053 ROCHESTER RD",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480851303",
            "telephone_number": "248-879-5858",
            "fax_number": "248-879-3578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SQUARE LAKE FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2008-01-31",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "PRITIDA",
        "authorized_official_middle_name": "TUSHAR",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "248-879-5858",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901015929",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901015961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Troy, MI
• Providers in Troy, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2008; 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.