Great Lakes Endodontics

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

2901019963 Issued in MI

Legal business name

GREAT LAKES ENDODONTICS

Practice address

950 Trade Centre Way
Ste 225
Portage, MI 49002-0487

Phone

(269) 349-2189

NPI assigned

Mar 24, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Robert Yeung, DDS, MSNPI 1407098056

Title

Owner

Phone

(269) 349-2189

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert S Yeung, DDS, MS

  • Dentist
  • Portage, MI
  • NPI 1407098056
  NPD (past) Authorized official

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

{
    "created_epoch": "1490313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490313600000",
    "number": "1659802395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 TRADE CENTRE WAY",
            "address_2": "STE 225",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490020487",
            "telephone_number": "269-349-2189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 TRADE CENTRE WAY",
            "address_2": "STE 225",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490020487",
            "telephone_number": "269-349-2189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES ENDODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-24",
        "last_updated": "2017-03-24",
        "status": "A",
        "authorized_official_last_name": "YEUNG",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-349-2189",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "MI",
            "license": "2901019963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Avery Gravelyn
• Antoinette Gray
• Alexandra Graziano
• Great Lakes Anesthesia Consultants PLLC
• Great Lakes Cardiovascular Thoracic Surgery, PLC
• Great Lakes Hand Therapy PC
• Great Lakes Hand Therapy PC
• Great Lakes Plastic Reconstructive & Hand Surgery P C
• Luigi Greco, O.D.
• Calley Nichole Green, RN

• Endodontics in Portage, MI
• Providers in Portage, MI by specialty
• Endodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 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.