Provider Demographics
NPI:1023296571
Name:GARY H. DWIGHT, D.D.S., P.C.
Entity type:Organization
Organization Name:GARY H. DWIGHT, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:H
Authorized Official - Last Name:DWIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:517-333-9500
Mailing Address - Street 1:818 W LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1308
Mailing Address - Country:US
Mailing Address - Phone:517-333-9500
Mailing Address - Fax:517-333-9509
Practice Address - Street 1:818 W LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1308
Practice Address - Country:US
Practice Address - Phone:517-333-9500
Practice Address - Fax:517-333-9509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI10120261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000001267OtherPHP
MI4045412Medicaid
MI5337261Medicare PIN
MI4045412Medicaid