Crystal Lynn Marciniak

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901019316 Issued in MI

Practice address

9178 E US Highway 223
Blissfield, MI 49228-9665

Phone

(517) 486-2030

NPI assigned

Apr 26, 2007

Last updated

Oct 10, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• 42 North Dental Care of Michigan, PLLC

  dba Great Lakes Family Dental, Blissfield

  • Dental Clinic/Center
  • Blissfield, MI
  • NPI 1912657602
  NPD (past)
• Great Lakes Family Dental Group Blissfield PC

  • General Practice Dentistry
  • Blissfield, MI
  • NPI 1386835999
  NPD (past)

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191974400000",
    "number": "1780804559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 CALHOUN AVE",
            "city": "CLINTON",
            "state": "MI",
            "postal_code": "492369459",
            "telephone_number": "517-456-6568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9178 E US HIGHWAY 223",
            "city": "BLISSFIELD",
            "state": "MI",
            "postal_code": "492289665",
            "telephone_number": "517-486-2030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARCINIAK",
        "first_name": "CRYSTAL",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-26",
        "last_updated": "2007-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901019316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James R Creps PT PC (James Creps Physical Therapy)
• Teresa Johnson
• Amanda Suzanna Koyl, PHARMD
• James Floyd Leonard, DVM
• Christopher M Mallow, D.D.S
• Jennifer McLemore
• Jessica Menna
• Ella M Noel, DO
• Sarah Pasternak
• Emily Theresa Louise Quinton, PT, DPT

• General Practice Dentistry in Blissfield, MI
• Providers in Blissfield, 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 Oct 10, 2007; 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.