Provider Demographics
NPI:1407322548
Name:GREAT LAKES BAY PEDIATRIC DENTISTRY, PLC
Entity Type:Organization
Organization Name:GREAT LAKES BAY PEDIATRIC DENTISTRY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:YAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:989-792-9201
Mailing Address - Street 1:5605 COLONY DR N STE 2
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-7187
Mailing Address - Country:US
Mailing Address - Phone:989-792-9201
Mailing Address - Fax:989-792-9199
Practice Address - Street 1:5605 COLONY DR N STE 2
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-7187
Practice Address - Country:US
Practice Address - Phone:989-792-9201
Practice Address - Fax:989-792-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty