Susan L Shore-Vignola, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901014317 Issued in MI

Practice address

213 S Canal St
Lake City, MI 49651-7929

Phone

(231) 839-2630

Fax

(231) 839-5751

NPI assigned

Aug 30, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lake City Family Dentistry

  • General Practice Dentistry
  • Lake City, MI
  • NPI 1528686748
  NPD
• Lake City Family Dentistry

  • General Practice Dentistry
  • Lake City, MI
  • NPI 1912572124
  NPD (past)

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462233600000",
    "number": "1952394439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 719",
            "city": "LAKE CITY",
            "state": "MI",
            "postal_code": "496510719",
            "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": "496517929",
            "telephone_number": "231-839-2630",
            "fax_number": "231-839-5751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORE-VIGNOLA",
        "first_name": "SUSAN",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-30",
        "last_updated": "2016-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901014317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4087824",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Eric Sendzik, PT
• Jordan Shepler
• Carol Anne Shetenhelm, L.P.C.
• Teresa Mae Shipton, LPTA
• Shopko Stores Operating Co LLC
• Samantha Simonetti, DPT, PT
• Elizabeth M Slack
• Brittney Smith
• Leeann Marie Smith, LMT
• Suzanne Smith

• 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 3, 2016; 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.