| East Lake Dental Pllc | |
|
201 S Lafayette St South Lyon MI 48178-1405 | |
| (248) 437-4119 | |
| Not Available |
| Full Name | East Lake Dental Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 201 S Lafayette St, South Lyon, Michigan |
| Authorized Official Name and Position | William Ryan Jenkins (OWNER DENTIST) |
| Authorized Official Contact | 2483219485 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| East Lake Dental Pllc 3542 Oakshire Ave Berkley MI 48072-3411 Ph: (248) 321-9485 | East Lake Dental Pllc 201 S Lafayette St South Lyon MI 48178-1405 Ph: (248) 437-4119 |
| NPI Number | 1104401645 |
|---|---|
| Provider Enumeration Date | 03/16/2021 |
| Last Update Date | 03/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104401645 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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