Great Lakes Family Dental Group-Dewitt, P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

GREAT LAKES FAMILY DENTAL GROUP-DEWITT, P.C.

Practice address

13109 Schavey Rd
Dewitt, MI 48820-9015

Phone

(517) 669-2415

NPI assigned

Jun 3, 2008

Last updated

Jun 5, 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

Patricia J. Hart

Title

Corporate Manager

Phone

(810) 625-2860

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1212451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212624000000",
    "number": "1801055009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13109 SCHAVEY RD",
            "city": "DEWITT",
            "state": "MI",
            "postal_code": "488209015",
            "telephone_number": "517-669-2415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13109 SCHAVEY RD",
            "city": "DEWITT",
            "state": "MI",
            "postal_code": "488209015",
            "telephone_number": "517-669-2415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES FAMILY DENTAL GROUP-DEWITT, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-03",
        "last_updated": "2008-06-05",
        "status": "A",
        "authorized_official_last_name": "HART",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CORPORATE MANAGER",
        "authorized_official_telephone_number": "810-625-2860"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Michael Gilliam, LMSW
• Kaylea Sayle Goerge-Flowers
• Alberto Gomez, OD
• Peter Timothy Graham, MD
• Faith June-Marie Gray, MA, CF-SLP
• Jessica Gross, RDH
• Lisa Eileen Gurd
• Danielle Elizabeth Guty
• Vaughn V Hafner, R.PH
• Hale Psychological Services LLC

• General Practice Dentistry in Dewitt, MI
• Providers in Dewitt, 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 Jun 5, 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.