Dr. Eldib Fort Gratiot, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

DR. ELDIB FORT GRATIOT, PLLC

Practice address

4036 24TH Ave
Fort Gratiot, MI 48059-3800

Phone

(810) 385-9766

Fax

(810) 990-8403

NPI assigned

Aug 21, 2024

Organization subpart

No

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

Authorized official

Name

Mrs. Kelley Varga

Title

Director of Business Operations

Phone

(734) 808-0000

Specialties & licenses 2

Addresses

Other names 1

• New Era Dental Doing business as

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

{
    "created_epoch": "1724198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742774400000",
    "number": "1841023264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4036 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593800",
            "telephone_number": "810-385-9766",
            "fax_number": "810-990-8403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4036 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593800",
            "telephone_number": "810-385-9766",
            "fax_number": "810-990-8403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. ELDIB FORT GRATIOT, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-21",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A",
        "authorized_official_last_name": "VARGA",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS OPERATIONS",
        "authorized_official_telephone_number": "734-808-0000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Era Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "New Era Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sophia Donnellon, PT, DPT
• Dakota Donovan
• Bridgette Douglas
• Amanda Lynn Doyle, LMT
• Dr Shores & Associates Optometrist Inc
• Angelic Latrice Drake
• Shelsy Dawn Drouillard
• Mary Drummond
• Coby Dubke
• Michael J. Duffy Jr., ED.D., L.L.P.

• Dental Clinic/Center in Fort Gratiot, MI
• Providers in Fort Gratiot, MI by specialty
• Dental Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; 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.