Individual provider Active NPI

Lisa M. Tartaglione, DDS

  • General Practice Dentistry
  • Grand Rapids, MI
National Provider Identifier
1821146903
Registry record updated Oct 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
015362 Issued in MI
Practice address
2060 E Paris Ave SE Ste 210
Grand Rapids, MI 49546-6113
Phone
(616) 949-7290
Fax
(616) 949-6108
NPI assigned
Jan 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 015362 MI Primary

Addresses

Primary practice location

2060 E Paris Ave SE Ste 210
Grand Rapids, MI 49546-6113

Mailing address

2060 E Paris Ave SE Ste 210
Grand Rapids, MI 49546-6113
Phone (616) 949-7290

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160531002491 MI Order and Referring Only - DentistPractitioner - Dentist 6406146638

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
015362MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Baker Dental Studio PLLC CurrentSince Mar 3, 2024 Accepting new patients
East Paris Dental Professionals PLC PastSince Nov 1, 2020 Accepting new patients

Locations

2060 East Paris Ave SE
Ste 210
Grand Rapids, MI 49546
Phone (440) 836-2188

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603929600000",
    "number": "1821146903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2060 E PARIS AVE SE STE 210",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466113",
            "telephone_number": "616-949-7290",
            "fax_number": "616-949-6108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 E PARIS AVE SE STE 210",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466113",
            "telephone_number": "616-949-7290",
            "fax_number": "616-949-6108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARTAGLIONE",
        "first_name": "LISA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-08",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "015362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.