# GREAT LAKES FAMILY DENTAL GROUP LANSING PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Professional Corporation
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205928322
- **Authorized official:** MRS. PATRICIA J HART (GENERAL MANAGER)
- **Authorized official phone:** (810) 238-6260

## Contact information

- **Practice address:** 609 E JOLLY ROAD, SUITE 10B, LANSING, MI 48910
- **Practice address phone:** (517) 882-7132
- **Practice address fax:** (517) 882-6608
- **Mailing address:** 609 E JOLLY ROAD, SUITE 10B, LANSING, MI 48910
- **Mailing address phone:** (517) 882-7132
- **Mailing address fax:** (517) 882-6608

## Taxonomy

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

## Other

- **Enumeration date:** 09/28/2006
- **Last updated:** 08/22/2020