Hart Family Dentistry PLLC
Organization Active NPI Dentist · Hart, MI
NPI 1902423239 · NPPES record last updated Jul 23, 2020
Key facts
- NPI
- 1902423239
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- Legal business name
- HART FAMILY DENTISTRY PLLC
- Practice address
- 110 S Dryden St
Hart, MI 49420-1105 - Phone
- (231) 873-4025
- NPI assigned
- Jul 2, 2020
- Organization subpart
- No
Authorized official
- Name
- Dr. Grant Kurtis Gillish, DDS
- Title
- Dentist/Owner
- Phone
- (231) 873-4025
Practitioners 3
-
Grant Kurtis Gillish, D.D.S.
-
Kimberly Sue Barrett, DDS
-
Peter Mason, DDS
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201123000422 | MI | Part B Supplier - Clinic/Group Practice | 4789095829 |
Receives reassigned benefits from 1 practitioner Practice locations: Hart, MI |
National Provider Directory
Locations
110 S Dryden St
Hart, MI 49420
Phone (231) 873-4025
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | Yes |
Addresses
Primary practice location
110 S Dryden St
Hart, MI 49420-1105
Mailing address
110 S Dryden St
Hart, MI 49420-1105
Phone (231) 873-4025
Other names
- Hart Lake Family Dentistry
Other providers in Hart, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.