NPIMap

Organization Active NPI

Great Lakes Family Dental Group - Grand Blanc

  • General Practice Dentistry
  • Grand Blanc, MI
National Provider Identifier
1720323173
Registry record updated Jun 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901012257 Issued in MI
Legal business name
GREAT LAKES FAMILY DENTAL GROUP - GRAND BLANC
Practice address
8542 Holly Road
Grand Blanc, MI 48439
Phone
(810) 603-7887
Fax
(810) 720-1306
NPI assigned
Dec 11, 2012
Last updated
Jun 13, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2018

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

Authorized official

Name
Dr. Clarence Patrick Gray, DDSNPI 1649362773
Title
Owner/President
Phone
(810) 732-0200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 2901012257 MI Primary

Addresses

Primary practice location

8542 Holly Road
Grand Blanc, MI 48439

Mailing address

8542 Holly Road
Grand Blanc, MI 48439
Phone (810) 603-7887

Other names 1

  • Great Lakes Family Dental Group - Flint Former legal business name

National Provider Directory

National Provider Directory

Locations

8542 Holly Rd
Grand Blanc, MI 48439
Phone (810) 603-7887

Practitioners & affiliated clinicians

Practitioners 4

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": "1355184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528848000000",
    "number": "1720323173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8542 HOLLY ROAD",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "48439",
            "telephone_number": "810-603-7887",
            "fax_number": "810-720-1306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8542 HOLLY ROAD",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "48439",
            "telephone_number": "810-603-7887",
            "fax_number": "810-720-1306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES FAMILY DENTAL GROUP - GRAND BLANC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-11",
        "last_updated": "2018-06-13",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "810-732-0200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901012257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Family Dental Group - Flint",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Grand Blanc, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2018; 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.