NPIMap

Organization Active NPI

42 North Dental Care of Michigan, PLLC

Doing business as Great Lakes Family Dental, Dexter

  • Dental Clinic/Center
  • Dexter, MI
National Provider Identifier
1679223374
Registry record updated Mar 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
42 NORTH DENTAL CARE OF MICHIGAN, PLLC
Doing business as
Great Lakes Family Dental, Dexter
Practice address
3060 Baker Rd
Dexter, MI 48130-1140
Phone
(734) 426-4651
NPI assigned
Mar 25, 2022
Last updated
Mar 25, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
42 NORTH DENTAL CARE OF MICHIGAN, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 25, 2022

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

Authorized official

Name
Michael Angelo Scialabba
Title
Chief Clincal Officer
Phone
(561) 512-2709

Specialties & licenses 1

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

Addresses

Primary practice location

3060 Baker Rd
Dexter, MI 48130-1140

Mailing address

3060 Baker Rd
Dexter, MI 48130-1140

Other names 1

  • Great Lakes Family Dental, Dexter Doing business as

National Provider Directory

National Provider Directory
Tax ID family
42 North Dental Care of Michigan PLLC12 organizations share this tax ID, including this one
Part of
42 North Dental Care of Michigan PLLC

Other organizations with this tax ID 11

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

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1648166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648166400000",
    "number": "1679223374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3060 BAKER RD",
            "city": "DEXTER",
            "state": "MI",
            "postal_code": "481301140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3060 BAKER RD",
            "city": "DEXTER",
            "state": "MI",
            "postal_code": "481301140",
            "telephone_number": "734-426-4651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "42 NORTH DENTAL CARE OF MICHIGAN, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "42 NORTH DENTAL CARE OF MICHIGAN, PLLC",
        "enumeration_date": "2022-03-25",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A",
        "authorized_official_last_name": "SCIALABBA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ANGELO",
        "authorized_official_title_or_position": "CHIEF CLINCAL OFFICER",
        "authorized_official_telephone_number": "561-512-2709"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Family Dental, Dexter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dexter, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.