# LISA M MUSGRAVE DDS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063881407
- **Authorized official:** DR. LISA M MUSGRAVE DDS (SOLE PROPRIETOR)
- **Authorized official phone:** (231) 882-9683

## Contact information

- **Practice address:** 124 S BENZIE BLVD, BEULAH, MI 49617-8546
- **Practice address phone:** (231) 882-9683
- **Practice address fax:** (231) 882-5192
- **Mailing address:** 124 S BENZIE BLVD, PO BOX 378, BEULAH, MI 49617-8546
- **Mailing address phone:** (231) 882-9683
- **Mailing address fax:** (231) 882-5192

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2901021135 | MI | Yes |

## Other

- **Enumeration date:** 09/16/2015
- **Last updated:** 09/16/2015