Provider Demographics
NPI:1467195958
Name:LAKE MICHIGAN ENDODONTICS OF GRAND HAVEN PLLC
Entity Type:Organization
Organization Name:LAKE MICHIGAN ENDODONTICS OF GRAND HAVEN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:DZINGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:616-935-7661
Mailing Address - Street 1:921 S BEECHTREE ST STE 6A
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2385
Mailing Address - Country:US
Mailing Address - Phone:616-935-7661
Mailing Address - Fax:616-935-7664
Practice Address - Street 1:921 S BEECHTREE ST STE 6A
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2385
Practice Address - Country:US
Practice Address - Phone:616-935-7661
Practice Address - Fax:616-935-7664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty