Provider Demographics
NPI:1467501130
Name:LANSING COMMUNITY COLLEGE
Entity Type:Organization
Organization Name:LANSING COMMUNITY COLLEGE
Other - Org Name:LANSING COMMUNITY COLLEGE DENTAL HYGIENE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ACADEMIC TEAM LEADER - DENTAL PRGM.
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, RDH, RDA
Authorized Official - Phone:517-483-1457
Mailing Address - Street 1:PO BOX 40010
Mailing Address - Street 2:MC 3100 DENTAL HYGIENE PROGRAM
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-7210
Mailing Address - Country:US
Mailing Address - Phone:517-483-1458
Mailing Address - Fax:517-483-9925
Practice Address - Street 1:515 N. WASHINGTON SQ.
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48933
Practice Address - Country:US
Practice Address - Phone:517-483-1458
Practice Address - Fax:517-483-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI88024122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty