1801007455 NPI number — JOHN P MCREE, D.D.S.,. L.L.C.

Table of content: (NPI 1801007455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801007455 NPI number — JOHN P MCREE, D.D.S.,. L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN P MCREE, D.D.S.,. L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801007455
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3555 PRATT LAKE AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49331-9376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-897-4807
Provider Business Mailing Address Fax Number:
616-842-2960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17088 ROBBINS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND HAVEN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49417-2791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-842-2960
Provider Business Practice Location Address Fax Number:
616-842-8550
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCREE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
616-842-2960

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2901014870 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: J800322 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 512010 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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