Provider Demographics
NPI:1467662841
Name:MICHIGAN DENTUREAND IMPLANT CENTER
Entity Type:Organization
Organization Name:MICHIGAN DENTUREAND IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:VERNIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-592-1100
Mailing Address - Street 1:26001 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-1440
Mailing Address - Country:US
Mailing Address - Phone:313-592-1100
Mailing Address - Fax:313-592-0061
Practice Address - Street 1:26001 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1440
Practice Address - Country:US
Practice Address - Phone:313-592-1100
Practice Address - Fax:313-592-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI144761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI818900OtherUNITED CONCORDIA
MI838921OtherUNITED CONCORDIA
MI802855OtherBLUE CROSS BLUE SHIELD