D&M Hispanic Dental Office BLDG LLC

Key facts

NPI

1720239189

Entity type

Organization (NPI type 2)

Primary specialty

Dentist 122300000X

Legal business name

D&M HISPANIC DENTAL OFFICE BLDG LLC

Practice address

840 Brookville PLZ SE
Grand Rapids, MI 49508-1315

Phone

(616) 301-0799

Fax

(616) 301-2130

NPI assigned

Oct 3, 2008

Organization subpart

No

Authorized official

Name

Ligia M Castanos

Title

Owner / Manager

Phone

(616) 301-0799

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 3, 2008.

{
    "created_epoch": "1222992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222992000000",
    "number": "1720239189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 BROOKVILLE PLZ SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495081315",
            "telephone_number": "616-301-0799",
            "fax_number": "616-301-2130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 BROOKVILLE PLZ SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495081315",
            "telephone_number": "616-301-0799",
            "fax_number": "616-301-2130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D&M HISPANIC DENTAL OFFICE BLDG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-03",
        "last_updated": "2008-10-03",
        "status": "A",
        "authorized_official_last_name": "CASTANOS",
        "authorized_official_first_name": "LIGIA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER / MANAGER",
        "authorized_official_telephone_number": "616-301-0799"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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