NPIMap

Organization Active NPI

L'Anse Family Dentistry PC

  • Dentist
  • L'Anse, MI
National Provider Identifier
1801176169
Registry record updated Sep 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901013208 Issued in MI
Legal business name
L'ANSE FAMILY DENTISTRY PC
Practice address
15647 Nordstrom St
Lanse, MI 49946-8439
Phone
(906) 524-6420
Fax
(906) 524-6821
NPI assigned
Aug 18, 2011
Last updated
Sep 1, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2011

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

Authorized official

Name
Mark G Summersett, DDSNPI 1134174204
Title
Dentist
Phone
(906) 524-6420

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
Dentist 122300000X 2901020319 MI
Dentist 122300000X 2901013208 MI Primary

Addresses

Primary practice location

15647 Nordstrom St
Lanse, MI 49946-8439

Mailing address

PO Box 9
15647 Nordstrom St
Lanse, MI 49946-0009
Phone (906) 524-6420

Other identifiers 1

IdentifierTypeStateIssuer
1778884MedicaidMI

National Provider Directory

National Provider Directory

Locations

15647 Nordstrom St
Lanse, MI 49946
Phone (906) 524-6420

Practitioners & affiliated clinicians

Practitioners 2

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": "1313625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314835200000",
    "number": "1801176169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "address_2": "15647 NORDSTROM ST",
            "city": "LANSE",
            "state": "MI",
            "postal_code": "499460009",
            "telephone_number": "906-524-6420",
            "fax_number": "906-524-6821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15647 NORDSTROM ST",
            "city": "LANSE",
            "state": "MI",
            "postal_code": "499468439",
            "telephone_number": "906-524-6420",
            "fax_number": "906-524-6821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "L'ANSE FAMILY DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-18",
        "last_updated": "2011-09-01",
        "status": "A",
        "authorized_official_last_name": "SUMMERSETT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "906-524-6420",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901020319",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901013208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1778884",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in L'Anse, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2011; 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.