Provider Demographics
NPI:1497536981
Name:LAKE MICHIGAN FAMILY DENTAL, PLLC
Entity Type:Organization
Organization Name:LAKE MICHIGAN FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:STRENG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-798-9911
Mailing Address - Street 1:939 E PONTALUNA RD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-9778
Mailing Address - Country:US
Mailing Address - Phone:231-798-9911
Mailing Address - Fax:231-799-9580
Practice Address - Street 1:939 E PONTALUNA RD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-9778
Practice Address - Country:US
Practice Address - Phone:231-798-9911
Practice Address - Fax:231-799-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental