Periodontal Specialists of Grand Blanc PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

16909 Issued in MI

Legal business name

PERIODONTAL SPECIALISTS OF GRAND BLANC PC

Practice address

8185 Holly Rd
Suite19
Grand Blanc, MI 48439-2444

Phone

(810) 695-6444

NPI assigned

Jan 24, 2008

Last updated

Jan 24, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Kelly Lynn Coggins

Title

Business Office Asst.

Phone

(810) 695-6444

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1201132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201132800000",
    "number": "1780861484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8185 HOLLY RD",
            "address_2": "SUITE19",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484392444",
            "telephone_number": "810-695-6444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8185 HOLLY RD",
            "address_2": "SUITE19",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484392444",
            "telephone_number": "810-695-6444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTAL SPECIALISTS OF GRAND BLANC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-24",
        "last_updated": "2008-01-24",
        "status": "A",
        "authorized_official_last_name": "COGGINS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "BUSINESS OFFICE ASST.",
        "authorized_official_telephone_number": "810-695-6444",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MI",
            "license": "16909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany S Peeler, MA, LLPC, NCC
• Tanya Marie Peet, MSW
• Angela Pena
• Melanie Rose Pendergrass, D.O.
• Tammy Pendleton
• Dey Perkins
• Mashya Clote Perkins
• Roman Permyakov, DO
• Eileen Joe'L Perrigo, PHYSICAL THERAPIST
• Chelsea Perrotta, LPTA

• Periodontics in Grand Blanc, MI
• Providers in Grand Blanc, MI by specialty
• Periodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2008; 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.