Active NPI
Michael Joseph Lilly, DMD
- Dentist
- Wayland, MI
National Provider Identifier
1609438803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901600219
- Practice address
- 899 Reno Dr
Wayland, MI 49348-1732 - Phone
- (269) 509-4155
- NPI assigned
- Jul 8, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901600219 | MI | Primary |
Addresses
Primary practice location
899 Reno Dr
Wayland, MI 49348-1732
Mailing address
1402 Silver Springs CT SE
Caledonia, MI 49316-8445
Phone (989) 330-5243
Other practice location 1
502 W Randall St
Coopersville, MI 49404-1341
Phone (616) 384-4129
Other practice location 2
404 W Superior St
Wayland, MI 49348-1223
Phone (269) 792-0144
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901600219 | MI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Robinson Community Dental Clinic | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Wayland, MI
- NPI 1174963375
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562544000000",
"number": "1609438803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1402 SILVER SPRINGS CT SE",
"city": "CALEDONIA",
"state": "MI",
"postal_code": "493168445",
"telephone_number": "989-330-5243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "899 RENO DR",
"city": "WAYLAND",
"state": "MI",
"postal_code": "493481732",
"telephone_number": "269-509-4155"
}
],
"practiceLocations": [
{
"address_1": "502 W Randall St",
"address_purpose": "LOCATION",
"city": "Coopersville",
"state": "MI",
"postal_code": "494041341",
"country_code": "US",
"telephone_number": "616-384-4129",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "404 W Superior St",
"address_purpose": "LOCATION",
"city": "Wayland",
"state": "MI",
"postal_code": "493481223",
"country_code": "US",
"telephone_number": "269-792-0144",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LILLY",
"first_name": "MICHAEL",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-08",
"last_updated": "2019-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901600219",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wayland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.