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EAST LAKE DENTAL PLLC
NPI 1104401645
Dentist - General Practice in South Lyon, MI

Active since March 16, 2021
201 S LAFAYETTE ST, SOUTH LYON, MI 48178(248) 437-4119 Get Directions Write a Review

NPPES record last updated: March 16, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About East Lake Dental Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EAST LAKE DENTAL PLLC (NPI 1104401645) is a healthcare organization registered as a general practice in South Lyon, Michigan and active in the NPI registry since March 2021. The organization lists William Ryan Jenkins, Owner Dentist, as its authorized official.

NPPES Registry Identity

NPI1104401645
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameEAST LAKE DENTAL PLLC
Location Address201 S LAFAYETTE STSouth Lyon, MI 48178-1405
Mailing Address3542 Oakshire AveBerkley, MI 48072-3411 · (248) 321-9485
Phone(248) 437-4119
Organization SubpartNo
Authorized OfficialWilliam Ryan JenkinsOwner Dentist · (248) 321-9485
Enumeration DateMarch 16, 2021
NPPES CertifiedMarch 12, 2021
✔ NPI 1104401645 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Definition
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.
201 S LAFAYETTE ST, South Lyon, MI 48178
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

OFFICE 5 PLLC
Dentist (Dental Public Health)
201 S LAFAYETTE ST
SOUTH LYON, MI 48178
Oakland County (248) 437-4119
DR. ROBERT BOROWIEC D.D.S.
Dentist (General Practice)
201 S LAFAYETTE ST
SOUTH LYON, MI 48178
Oakland County (248) 437-4119
SOUTH LYON DENTAL GROUP, P.L.C.
Dentist (General Practice)
201 S LAFAYETTE ST
SOUTH LYON, MI 48178
Oakland County (248) 437-4119
DR. EDWARD F STIMAC D.D.S.
Dentist (General Practice)
201 S LAFAYETTE ST
SOUTH LYON, MI 48178
Oakland County (248) 437-4119

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is East Lake Dental PLLC's NPI number?

The NPI number for East Lake Dental PLLC is 1104401645. It was assigned to this organization in the NPPES registry on March 16, 2021.

Where is East Lake Dental PLLC located?

East Lake Dental PLLC is located at 201 S Lafayette St, South Lyon, MI 48178. The listed phone number is (248) 437-4119.

What is East Lake Dental PLLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for East Lake Dental PLLC was last updated on March 16, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.