# MANISTIQUE DENTAL CENTER, P.C.

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

## Provider details

- **NPI number:** 1093980955
- **Authorized official:** GREGORY DAVID LAFAYETTE DDS (PRESIDENT)
- **Authorized official phone:** (906) 341-6132

## Contact information

- **Practice address:** 115 N LAKE ST LOWR LEVEL, MANISTIQUE, MI 49854-1234
- **Practice address phone:** (906) 341-6132
- **Practice address fax:** (906) 341-3054
- **Mailing address:** 115 N LAKE ST LOWR LEVEL, MANISTIQUE, MI 49854-1234
- **Mailing address phone:** (906) 341-6132
- **Mailing address fax:** (906) 341-3054

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2901016294 | MI | Yes |

## Other

- **Enumeration date:** 04/22/2008
- **Last updated:** 04/22/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1558410902 | — | MI |