Lakeside Pediatric Dental Specialists

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2901018671 Issued in MI

Legal business name

LAKESIDE PEDIATRIC DENTAL SPECIALISTS

Practice address

1952 Holland Ave
Port Huron, MI 48060-1520

Phone

(810) 985-9660

Fax

(810) 985-9666

NPI assigned

Aug 20, 2014

Last updated

Aug 20, 2014By 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. Phillip Glenn Monroy, DDS, MS

Title

Owner

Phone

(810) 985-9660

Specialties & licenses 1

Addresses

Locations

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.

• George E Tache, DDS

  • Pediatric Dentistry
  • Port Huron, MI
  • NPI 1952311193
  NPD (past)

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

{
    "created_epoch": "1408492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408492800000",
    "number": "1891194379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1952 HOLLAND AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480601520",
            "telephone_number": "810-985-9660",
            "fax_number": "810-985-9666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1952 HOLLAND AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480601520",
            "telephone_number": "810-985-9660",
            "fax_number": "810-985-9666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE PEDIATRIC DENTAL SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-20",
        "last_updated": "2014-08-20",
        "status": "A",
        "authorized_official_last_name": "MONROY",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "GLENN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-985-9660",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MI",
            "license": "2901018671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Elizabeth Laduke
• Cynthia Lee Laeder, CRNA
• Michael Alan Laeder, RPH
• Donald Lake, FNP-C
• Margaret Lake
• Lakeview Chiropractic Inc
• Jenna Marie Lakin
• Anup Lal, MD
• Sharon Lancaster
• Brian Lewis Landon III

• Pediatric Dentistry in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Pediatric Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2014; 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.