Provider Demographics
NPI:1235308826
Name:GREAT LAKES FAMILY DENTALGROUP-HOWELL
Entity Type:Organization
Organization Name:GREAT LAKES FAMILY DENTALGROUP-HOWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-546-7921
Mailing Address - Street 1:3169 CHARANN DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8612
Mailing Address - Country:US
Mailing Address - Phone:517-546-7921
Mailing Address - Fax:
Practice Address - Street 1:3169 CHARANN DR
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8612
Practice Address - Country:US
Practice Address - Phone:517-546-7921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty