Provider Demographics
NPI:1568739308
Name:EAST LANSING DENTAL PLLC
Entity Type:Organization
Organization Name:EAST LANSING DENTAL PLLC
Other - Org Name:DR. LAUREN HALL-TATE
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HALL-TATE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-351-9070
Mailing Address - Street 1:200 N HOMER ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4741
Mailing Address - Country:US
Mailing Address - Phone:517-351-9070
Mailing Address - Fax:517-351-6036
Practice Address - Street 1:200 N HOMER ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4741
Practice Address - Country:US
Practice Address - Phone:517-351-9070
Practice Address - Fax:517-351-6036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013605261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental