Provider Demographics
NPI:1699808576
Name:GRAND BLANC DENTAL CENTER P.C.
Entity Type:Organization
Organization Name:GRAND BLANC DENTAL CENTER P.C.
Other - Org Name:CONVENIENT FAMILY DENTISTRY P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:IRVING
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-694-7450
Mailing Address - Street 1:9499 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8351
Mailing Address - Country:US
Mailing Address - Phone:810-694-7450
Mailing Address - Fax:810-695-8222
Practice Address - Street 1:9499 HOLLY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8351
Practice Address - Country:US
Practice Address - Phone:810-694-7450
Practice Address - Fax:810-695-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010090151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty