Hart Lake Family Dentistry is a medicare enrolled dental clinic (Dentist) in Hart, Michigan. The current practice location for Hart Lake Family Dentistry is 110 S Dryden St, Hart, Michigan. For appointments, you can reach them via phone at
(231) 873-4025. The mailing address for Hart Lake Family Dentistry is 110 S Dryden St, Hart, Michigan and phone number is (231) 873-4025.
Hart Lake Family Dentistry is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its
NPI number is 1902423239. This medical practice
accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at
(231) 873-4025.
Dental Care Clinic Profile
| Full Name | Hart Lake Family Dentistry |
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| Speciality | Dentist |
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| Location | 110 S Dryden St, Hart, Michigan |
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| Authorized Official Name and Position | Grant Kurtis Gillish (DENTIST/OWNER) |
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| Authorized Official Contact | 2318734025 |
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| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
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Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Hart Lake Family Dentistry
110 S Dryden St
Hart
MI 49420-1105
Ph: (231) 873-4025 | Hart Lake Family Dentistry
110 S Dryden St
Hart
MI 49420-1105
Ph: (231) 873-4025 |
NPI Details:
| NPI Number | 1902423239 |
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| Provider Enumeration Date | 07/02/2020 |
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| Last Update Date | 07/23/2020 |
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Medicare PECOS Information:
| Medicare PECOS PAC ID | 4789095829 |
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| Medicare Enrollment ID | O20201123000422 |
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Medical Identifiers
Medical identifiers for Hart Lake Family Dentistry such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1902423239 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 122300000X | Dentist | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Hart Lake Family Dentistry acts as a billing entity for following providers:
| Provider Name | Grant K Gillish |
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| Provider Type | Practitioner - Dentist |
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| Provider Identifiers | NPI Number: 1659681591
PECOS PAC ID: 5799088720
Enrollment ID: I20201222000947 |
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