Provider Demographics
NPI:1811629611
Name:DAHL, GRACE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:M
Last Name:DAHL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 E BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2309
Mailing Address - Country:US
Mailing Address - Phone:517-512-2617
Mailing Address - Fax:
Practice Address - Street 1:4912 W ST JOE HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4090
Practice Address - Country:US
Practice Address - Phone:517-886-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601428APP221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice