| Great Lakes Family Dental Group-lansing, P.c. | |
|
3515 Coolidge Road Suite C East Lansing MI 48823 | |
| (517) 332-2422 | |
| Not Available |
| Full Name | Great Lakes Family Dental Group-lansing, P.c. |
|---|---|
| Speciality | Dentist |
| Location | 3515 Coolidge Road, East Lansing, Michigan |
| Authorized Official Name and Position | C. Patrick Gray (OWNER) |
| Authorized Official Contact | 8107320200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Family Dental Group-lansing, P.c. 3515 Coolidge Rd Suite C East Lansing MI 48823-8014 Ph: (810) 230-3245 | Great Lakes Family Dental Group-lansing, P.c. 3515 Coolidge Road Suite C East Lansing MI 48823 Ph: (517) 332-2422 |
| NPI Number | 1366873937 |
|---|---|
| Provider Enumeration Date | 12/09/2013 |
| Last Update Date | 02/08/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366873937 | NPI | - | NPPES |
| PTAN7290590001 | Other | MI | PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 12257 (Michigan) | Primary |
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