TLC DENTAL OF WALLED LAKE, PLLC (NPI# 1104925775) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104925775 |
| Entity Type | Organization |
| Organization Name | TLC DENTAL OF WALLED LAKE, PLLC |
| Practice Address |
1264 S Commerce Rd Walled Lake MI 48390-3008 |
| Practice Telephone | 2486244774 |
| Practice Fax Number | 2486249256 |
| Mailing Telephone | 2486244774 |
| Mailing Fax Number | 2486249256 |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. KURT HEUERMAN (OWNER) |
| Authorized Official Telephone | 2486244774 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
18099 | MI | Dental Providers |
| N | 1223G0001X |
Dentist Specialization: General Practice |
2901018746 | MI | Dental Providers |
| Y | 1223G0001X |
Dentist Specialization: General Practice |
17214 | MI | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | DDS | 17087 | 01 |
| Street Address |
1264 S COMMERCE RD |
| City | WALLED LAKE |
| State | MI |
| Zip Code | 48390-3008 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366792657 | Ronald Mishko II | Dentist | 1264 S Commerce Rd, Walled Lake, MI 48390-3008 | 2012-09-13 |
| 1588838759 | Convenient Wl, PC | Dentist | 1264 S Commerce Rd, Walled Lake, MI 48390-3008 | 2008-04-17 |
| 1881720548 | Khaldoun M Tarabin | Dentist | 1264 S Commerce Rd, Walled Lake, MI 48390-3008 | 2007-02-26 |
| 1346318698 | Shikha Sood | Dentist | 1264 S Commerce Rd, Walled Lake, MI 48390-3008 | 2006-12-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043820913 | Elizabeth Ann Manela | Speech-Language Pathologist | 2075 East West Maple Road, Suite B203, Walled Lake, MI 48390 | 2020-08-05 |
| 1205459674 | Allor Outdoor Services LLC | Chore Provider | 3225 E Oakley Park Rd, Commerce Twp, MI 48390 | 2020-05-20 |
| 1467004382 | Convenient Cm PC | Dentist | 2655 Oakley Park Rd, Suite 101, Commerce Twp, MI 48390 | 2019-07-11 |
| 1629535117 | Valerie Baunoch | Nurse Practitioner | 2057 E West Maple Rd, Commerce Twp, MI 48390 | 2019-02-21 |
| 1255858296 | Finn Family Chiropractic Pllc | Chiropractor | 2344 South Commerce Road, Walled Lake, MI 48390 | 2017-08-29 |
| 1588012629 | Shane Macphee | Chiropractor | 2901 Commerce Crossings, Commerce Township, MI 48390 | 2016-05-31 |
| 1245690114 | Lisa Jensen | Nurse Practitioner | 100 West Maple Rd., Walled Lake, MI 48390 | 2016-03-04 |
| 1255725123 | Carissa Karanth | Counselor | 1500 Rustic Lane, Wolverine Lake, MI 48390 | 2015-03-27 |
| 1689095093 | Mabell Omoye Scott | Licensed Vocational Nurse | 724 Owl Court, Wolverine Lake, MI 48390 | 2014-01-02 |
| 1093002230 | Ilze Liene Junkulis-muller | Pharmacist | 495 Haggerty, Traget Pharmacy #0896, Walled Lake, MI 48390 | 2011-07-08 |
| Find all providers in zip 48390 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255948790 | Jamie L Hafke Dds Pllc | Dentist | 1955 N Pontiac Trl, Walled Lake, MI 48390-3157 | 2020-09-29 |
| 1528077435 | Stephen Eric Jacobson | Dentist | 39890 W 14 Mile Rd., Walled Lake, MI 48390-3911 | 2006-08-07 |
| 1457399016 | Darren James Schweymaier | Dentist | 2340 S Commerce Rd, Walled Lake, MI 48390-2126 | 2006-06-03 |
| 1750388096 | Steven Hechtman | Dentist | 55 N Pond Dr, Ste 3, Walled Lake, MI 48390-3080 | 2005-07-01 |
| 1518458330 | Ryan P Rivamonte | Dentist | 2340 S Commerce Rd, Walled Lake, MI 48390-2174 | 2018-05-29 |
| 1366792657 | Ronald Mishko II | Dentist | 1264 S Commerce Rd, Walled Lake, MI 48390-3008 | 2012-09-13 |
| 1669648945 | Michael P Mcnutt D.d.s., P.C. | Dentist | 1881 N Pontiac Trl, Suite A, Walled Lake, MI 48390-3101 | 2008-05-06 |
| 1588838759 | Convenient Wl, PC | Dentist | 1264 S Commerce Rd, Walled Lake, MI 48390-3008 | 2008-04-17 |
| 1902019177 | Nelson J Sherburne | Dentist | 1052 E West Maple Rd, Walled Lake, MI 48390-3571 | 2007-05-07 |
| 1821210568 | Michael Patrick Mcnutt | Dentist | 1881 N Pontiac Trl, Suite A, Walled Lake, MI 48390-3101 | 2007-05-03 |
| Find all providers in WALLED LAKE | ||||
| City | WALLED LAKE |
| Zip Code | 48390 |
Please comment or provide details below to improve the information on TLC DENTAL OF WALLED LAKE, 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.