Lake Odessa Dental, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

LAKE ODESSA DENTAL, PLLC

Doing business as

Lake Odessa Dental Associates

Practice address

1032 4TH Ave
Lake Odessa, MI 48849-1004

Phone

(616) 374-8828

Fax

(616) 374-7934

NPI assigned

Apr 30, 2018

Last updated

Apr 30, 2018By 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

Dr. Michael Joseph Crete, DDSNPI 1790831402

Title

Member

Phone

(616) 560-3625

Specialties & licenses 1

Addresses

Other names 1

• Lake Odessa Dental Associates Doing business as

Practitioners 1

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.

• Michael J Crete, DDS

  • General Practice Dentistry
  • Lake Odessa, MI
  • NPI 1790831402
  NPD (past) Authorized official

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

{
    "created_epoch": "1525046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525046400000",
    "number": "1851889471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 SAN LU RAE DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495063425",
            "telephone_number": "616-560-3625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 4TH AVE",
            "city": "LAKE ODESSA",
            "state": "MI",
            "postal_code": "488491004",
            "telephone_number": "616-374-8828",
            "fax_number": "616-374-7934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE ODESSA DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-30",
        "last_updated": "2018-04-30",
        "status": "A",
        "authorized_official_last_name": "CRETE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "616-560-3625",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Odessa Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John P. Hemming, O.D.
• Chad Ronald Hickey, D.C.
• Jordan Christian Counseling
• Linda L. Kimmel, MA, LPC
• Kathryn Kutas
• Lake Odessa Pharmacy (Lake O Rx)
• Lansing Ophthalmology, PC (LO Eye Care)
• Laurie S Braker MD PLC
• Gerald T Licari, DDS
• Lo Optical, LLC

• Dental Clinic/Center in Lake Odessa, MI
• Providers in Lake Odessa, 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 Apr 30, 2018; 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.