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

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

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

Practice address

21635 Ryan Rd
Warren, MI 48091-2788

Phone

(810) 230-2345

Fax

(810) 230-3229

NPI assigned

Sep 29, 2016

Last updated

Sep 29, 2016By 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

Mrs. Patricia J. Hart

Title

Corporate Manager

Phone

(810) 625-2860

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1475107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475107200000",
    "number": "1801345061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "G3222 BEECHER RD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21635 RYAN RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480912788",
            "telephone_number": "810-230-2345",
            "fax_number": "810-230-3229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES FAMILY DENTAL GROUP-WARREN, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-29",
        "last_updated": "2016-09-29",
        "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",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Warren, MI
• Providers in Warren, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2016; 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.