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LAKE ODESSA DENTAL PLLC NPI 1851889471


NPI Information

NPI: 1851889471
Provider Name: LAKE ODESSA DENTAL, PLLC

Doing Business As: LAKE ODESSA DENTAL ASSOCIATES

Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

CLIA Number: 23D2256840

Address:
1032 4TH AVE
LAKE ODESSA, MI
ZIP 48849
Phone: (616) 374-8828
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LAKE ODESSA DENTAL, PLLC is a dental clinic center in Lake Odessa, MI. LAKE ODESSA DENTAL, PLLC NPI is 1851889471. The provider is registered as an organization entity type.
The provider Is Doing Business As Lake Odessa Dental Associates.

The provider's business location address is:

1032 4TH AVE
LAKE ODESSA, MI
ZIP 48849-004
Phone: (616) 374-8828
Fax: (616) 374-7934

The provider's authorized official is Michael Joseph Crete .
The authorized official title is Member and has the following contact phone number (616) 560-3625.

The CLIA number assigned to this NPI record is 23D2256840 - other - fire department with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/30/2018 and was last updated on 4/30/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QD0000XClinic/CenterDentalYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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