Provider Demographics
NPI:1558971408
Name:MID MICHIGAN GENTLE DENTAL
Entity Type:Organization
Organization Name:MID MICHIGAN GENTLE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LEZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-543-7991
Mailing Address - Street 1:114 S COCHRAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1510
Mailing Address - Country:US
Mailing Address - Phone:517-543-7991
Mailing Address - Fax:
Practice Address - Street 1:114 S COCHRAN AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1510
Practice Address - Country:US
Practice Address - Phone:517-543-7991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID MICHIGAN GENERAL DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental