NPIMap

Organization Active NPI

Mark D. Krull DDS PLLC

Doing business as Harborside Dental

  • General Practice Dentistry
  • Traverse City, MI
National Provider Identifier
1891455267
Registry record updated Dec 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MARK D. KRULL DDS PLLC
Doing business as
Harborside Dental
Practice address
13300 S West Bay Shore Dr Ste 1
Traverse City, MI 49684-5571
Phone
(231) 946-0207
NPI assigned
Dec 27, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2021

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

Authorized official

Name
Dr. Mark David Krull, DDSNPI 1902397425
Title
Owner
Phone
(231) 218-3944

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

13300 S West Bay Shore Dr Ste 1
Traverse City, MI 49684-5571

Mailing address

13300 S West Bay Shore Dr Ste 1
Traverse City, MI 49684-5571
Phone (231) 946-0207

Other names 1

  • Harborside Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1640563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640563200000",
    "number": "1891455267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13300 S WEST BAY SHORE DR STE 1",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496845571",
            "telephone_number": "231-946-0207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13300 S WEST BAY SHORE DR STE 1",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496845571",
            "telephone_number": "231-946-0207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK D. KRULL DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-27",
        "last_updated": "2021-12-27",
        "certification_date": "2021-12-27",
        "status": "A",
        "authorized_official_last_name": "KRULL",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-218-3944",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harborside Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2021; 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.