LAKE ODESSA DENTAL, PLLC (NPI# 1851889471) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1851889471 |
Entity Type | Organization |
Organization Name | LAKE ODESSA DENTAL, PLLC |
Other Organization Name | LAKE ODESSA DENTAL ASSOCIATES |
Practice Address |
1032 4th Ave Lake Odessa MI 48849-1004 |
Mailing Address |
2101 San Lu Rae Dr Se Grand Rapids MI 49506-3425 |
Practice Telephone | 6163748828 |
Practice Fax Number | 6163747934 |
Mailing Telephone | 6165603625 |
Enumeration Date | 2018-04-30 |
Last Update Date | 2018-04-30 |
Authorized Official Name | DR. MICHAEL JOSEPH CRETE (MEMBER) |
Authorized Official Telephone | 6165603625 |
Authorized Official Credential | DDS |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
Other Name | Type Code |
---|---|
Lake Odessa Dental Associates | Doing Business As Name - Organization |
Street Address |
1032 4TH AVE |
City | LAKE ODESSA |
State | MI |
Zip Code | 48849-1004 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1215024369 | Gerald T Licari Dds PC | Dentist | 1032 4th Ave, Lake Odessa, MI 48849-1004 | 2006-10-09 |
1790831402 | Michael J Crete | Dentist | 1032 4th Ave, Lake Odessa, MI 48849-1004 | 2007-01-26 |
1376630327 | Gerald T Licari | Dentist | 1032 4th Ave, Lake Odessa, MI 48849-1004 | 2006-10-09 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1851512339 | Christine Margaret Thomas | Pharmacist | 838 Fouth Ave, Lake Odessa, MI 48849 | 2007-05-01 |
1275641649 | Advanced Rx LLC | Pharmacy | 838 4th Avenue, Lake Odessa, MI 48849 | 2006-08-27 |
1578580080 | Total Health Center Hastings Inc | Physical Therapist | 4294 Laurel Dr, Ste 2, Lake Odessa, MI 48849 | 2006-07-17 |
1831608108 | Lake Odessa Pharmacy | Pharmacy | 802 4th Ave, Lake Odessa, MI 48849-1002 | 2017-09-29 |
1104914001 | William H Walker | Pharmacist | 838 4th Ave, Lake Odessa, MI 48849-1002 | 2006-10-10 |
1851340335 | Catherine Hemingway | Dental Hygienist | 924 4th Ave, Lake Odessa, MI 48849-1003 | 2006-05-10 |
1639258320 | Aaron Blane Freeman | Dentist | 924 4th Ave, Lake Odessa, MI 48849-1003 | 2006-11-03 |
1083133607 | Vicki Davison | Psychologist | 1040 4th Ave, Lake Odessa, MI 48849-1004 | 2017-09-14 |
1558320846 | Clarence Richard Barnett | Family Medicine | 1020 4th Ave, Lake Odessa, MI 48849-1004 | 2006-03-23 |
1447380324 | Clarence Richard Barnett Md Plc | Family Medicine | 1020 4th Ave, Lake Odessa, MI 48849-1004 | 2007-03-07 |
Find all providers in zip 48849 |
Taxonomy Code | 261QD0000X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Dental |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1144821216 | Inspired Family Dental Care | Clinic/Center | 1685 Fairholme Rd, Grosse Pointe Woods, MI 48236-2368 | 2020-11-05 |
1376144261 | Right Choice Dental, PC | Clinic/Center | 475 Columbia Ave E Ste 5, Battle Creek, MI 49014-5461 | 2020-11-05 |
1669073813 | Thomas M Smith, Dds, Plc | Clinic/Center | 755 Seminole Rd Ste 103, Norton Shores, MI 49441-6561 | 2020-11-04 |
1235739533 | Randy J Breen Dds Pllc | Clinic/Center | 2460 Burton St Se Ste 201, Grand Rapids, MI 49546-4800 | 2020-10-27 |
1831798370 | Saline Dental Care, Pllc | Clinic/Center | 150 Judd Rd, Milan, MI 48160-9584 | 2020-10-24 |
1235738113 | David Sorial Dds PC | Clinic/Center | 14755 Northline Rd, Southgate, MI 48195-2407 | 2020-10-21 |
1598363970 | Steven M Moss Dds PC | Clinic/Center | 37625 Ann Arbor Rd Ste 108, Livonia, MI 48150-2400 | 2020-10-16 |
1700484375 | Troy Cosmetic and Implant Dental Center Pllc | Clinic/Center | 4770 Rochester Rd Ste 106, Troy, MI 48085-4951 | 2020-10-15 |
1194323303 | Aq Dental Group Pllc | Clinic/Center | 10413 Ford Road, Units M & N, Dearborn, MI 48126 | 2020-10-12 |
1245837806 | Kendall J Lee Dds Pllc | Clinic/Center | 111 S Howell St, Hillsdale, MI 49242-1873 | 2020-10-07 |
Find all providers with the same taxonomy |
City | LAKE ODESSA |
Zip Code | 48849 |
Please comment or provide details below to improve the information on LAKE ODESSA DENTAL, PLLC.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.