GREAT LAKES FAMILY DENTAL GROUP-DEWITT, P.C.

NPI: 1801055009 · DEWITT, MI 48820 · General Practice Dentistry · NPI assigned 06/03/2008

$3K

Total Medicaid Paid

107

Total Claims

107

Beneficiaries

Codes Billed

2020-08

First Month

2021-03

Last Month

Provider Details

Authorized Official	HART, PATRICIA (CORPORATE MANAGER)
NPI Enumeration Date	06/03/2008

Other providers sharing the same authorized official: HART, PATRICIA

Provider	City	State	Total Paid
GREAT LAKES FAMILY DENTAL GROUP SAGINAW, PC	SAGINAW	MI	$436K
GREAT LAKES FAMILY DENTAL GROUP-MUNCIE, P.C.	MUNCIE	IN	$429K
C PATRICK GRAY DDS PC	FLINT	MI	$310K
GREAT LAKES FAMILY DENTAL GROUP BLISSFIELD PC	BLISSFIELD	MI	$142K
GREAT LAKES FAMILY DENTAL GROUP - TECUMSEH PC	TECUMSEH	MI	$102K
GREAT LAKES FAMILY DENTAL GROUP-ALMONT,P.C.	ALMONT	MI	$68K
GREAT LAKES FAMILY DENTAL GROUP-WARREN, P.C.	WARREN	MI	$30K
GREAT LAKES FAMILY DENTAL GROUP - MT MORRIS PC	MT MORRIS	MI	$15K
GREAT LAKES FAMILY DENTAL GROUP-ST. JOSEPH	SAINT JOSEPH	MI	$3K
GREAT LAKES FAMILY DENTALGROUP-HOWELL	HOWELL	MI	$3K

Year	Claims	Total Paid
2020	83	$2K
2021	24	$600.00

Code	Description	Claims	Beneficiaries	Total Paid
D1120	Prophylaxis - child	29	29	$960.00
D0120	Periodic oral evaluation - established patient	37	37	$952.00
D1208	Topical application of fluoride, excluding varnish	41	41	$864.00