Lake City Family Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

LAKE CITY FAMILY DENTISTRY

Practice address

213 S Canal St
Lake City, MI 49651-8865

Phone

(231) 839-2630

Fax

(231) 839-5751

NPI assigned

May 21, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Mitch Ty Carpenter-Thompson, DMDNPI 1134746290

Title

Owner/Dentist

Phone

(231) 839-2630

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

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

• Mitch Ty Carpenter-Thompson

  • General Practice Dentistry
  • Lake City, MI
  • NPI 1134746290
  NPD Authorized official
• Susan L Shore-Vignola, D.D.S.

  • General Practice Dentistry
  • Lake City, MI
  • NPI 1952394439
  NPD (past)

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

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621555200000",
    "number": "1912572124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 S CANAL ST",
            "address_2": "PO BOX 719",
            "city": "LAKE CITY",
            "state": "MI",
            "postal_code": "49651",
            "telephone_number": "231-839-2630",
            "fax_number": "231-839-5751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 S CANAL ST",
            "city": "LAKE CITY",
            "state": "MI",
            "postal_code": "496518865",
            "telephone_number": "231-839-2630",
            "fax_number": "231-839-5751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CITY FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-21",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-05",
        "status": "A",
        "authorized_official_last_name": "CARPENTER-THOMPSON",
        "authorized_official_first_name": "MITCH",
        "authorized_official_middle_name": "TY",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "231-839-2630",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "600446",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kahlee C Kenwabikise
• Christine Louise Klein, OTR
• David Robert Kramp, P.T.
• Michael Francis Lahey, DDS
• Lake City Family Dentistry
• Lake City Primary Care PC
• Lake Life Afc LLC
• Lake to Lake Transportation LLC
• Gregory Lambourne, M.D.
• Joseph Matthew Liestenfeltz

• General Practice Dentistry in Lake City, MI
• Providers in Lake City, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 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.