Great Lakes Dental Services PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

GREAT LAKES DENTAL SERVICES PLLC

Practice address

5621 Leslie CT
Flint, MI 48504

Phone

(810) 308-5086

NPI assigned

Apr 5, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Rudolph Delano Wheaton, DDS

Title

Director

Phone

(810) 308-5086

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1554422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554422400000",
    "number": "1730641804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5621 LESLIE CT",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "48504",
            "telephone_number": "810-308-5086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5621 LESLIE CT",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "48504",
            "telephone_number": "810-308-5086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES DENTAL SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-05",
        "last_updated": "2019-04-05",
        "status": "A",
        "authorized_official_last_name": "WHEATON",
        "authorized_official_first_name": "RUDOLPH",
        "authorized_official_middle_name": "DELANO",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "810-308-5086",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Ann Graybill, PA-C
• Kaisha Maran Grear
• Great Health Medical Mi PC
• Great Lakes Brain Spine Surgery and Pain Center PLLC
• Great Lakes Chiropractic & Movement PLLC
• Great Lakes Interventional Pain Management,PLLC
• Great Lakes Oral Surgery and Implants, P.C. (Greater Michigan Oral Surgeons & Dental Implant Center)
• Great Lakes Orthotics and Prosthetics (Great lakes O and P)
• Great Lakes Pain & Rehab, PC
• Great Lakes Recovery Mission

• General Practice Dentistry in Flint, MI
• Providers in Flint, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 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.

Verify at the official NPI Registry.