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Contact Information

GREAT LAKES ENDODONTICS
950 TRADE CENTRE WAY
STE 225
PORTAGE, MI49002-0487
 Phone: 269-349-2189
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Endodontics

1223E0200X
Indicates primary specialty

NPI Profile & details for GREAT LAKES ENDODONTICS

NPI Number 1659802395
LBN Legal business name GREAT LAKES ENDODONTICS
Authorized official ROBERT YEUNG - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 03/24/2017
Last updated 03/24/2017 - About 9 years ago
Identifiers
MI License # 2901019963
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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