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LAKESIDE PEDIATRIC DENTAL SPECIALISTS
NPI 1891194379
Dentist - Pediatric Dentistry in Port Huron, MI

Active since August 20, 2014
1952 HOLLAND AVE, PORT HURON, MI 48060(810) 985-9660(810) 985-9666 Get Directions Write a Review

NPPES record last updated: August 20, 2014. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Lakeside Pediatric Dental Specialists NPPES

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

LAKESIDE PEDIATRIC DENTAL SPECIALISTS (NPI 1891194379) is a healthcare organization registered as a pediatric dentistry in Port Huron, Michigan and active in the NPI registry since August 2014. The organization lists Phillip Glenn Monroy, Owner, as its authorized official.

NPPES Registry Identity

NPI1891194379
Entity TypeOrganization
Primary Taxonomy1223P0221X
Legal Business NameLAKESIDE PEDIATRIC DENTAL SPECIALISTS
Location Address1952 HOLLAND AVEPort Huron, MI 48060-1520
Mailing Address1952 Holland AvePort Huron, MI 48060-1520 · (810) 985-9660 · Fax (810) 985-9666
Phone(810) 985-9660
Fax(810) 985-9666
Organization SubpartNo
Authorized OfficialPhillip Glenn MonroyOwner · (810) 985-9660
Enumeration DateAugust 20, 2014
✔ NPI 1891194379 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
License✔ Licensed in MI · 2901018671
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
1952 HOLLAND AVE, Port Huron, MI 48060
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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

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

DR. GEORGE E TACHE DDS
Dentist (Pediatric Dentistry)
1952 HOLLAND AVE
PORT HURON, MI 48060
St. Clair County (810) 985-9660

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 Lakeside Pediatric Dental Specialists's NPI number?

The NPI number for Lakeside Pediatric Dental Specialists is 1891194379. It was assigned to this organization in the NPPES registry on August 20, 2014.

Where is Lakeside Pediatric Dental Specialists located?

Lakeside Pediatric Dental Specialists is located at 1952 Holland Ave, Port Huron, MI 48060. The listed phone number is (810) 985-9660.

What is Lakeside Pediatric Dental Specialists's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

When was this NPI record last updated?

The NPPES record for Lakeside Pediatric Dental Specialists was last updated on August 20, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.