# GREAT LAKES ENDODONTICS

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659802395
- **Authorized official:** DR. ROBERT YEUNG DDS, MS (OWNER)
- **Authorized official phone:** (269) 349-2189

## Contact information

- **Practice address:** 950 TRADE CENTRE WAY, STE 225, PORTAGE, MI 49002-0487
- **Practice address phone:** (269) 349-2189
- **Mailing address:** 950 TRADE CENTRE WAY, STE 225, PORTAGE, MI 49002-0487
- **Mailing address phone:** (269) 349-2189

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 2901019963 | MI | Yes |

## Other

- **Enumeration date:** 03/24/2017
- **Last updated:** 03/24/2017