# GREAT LAKES FAMILY DENTAL GROUP-LANSING, P.C.

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

## Provider details

- **NPI number:** 1366873937
- **Authorized official:** DR. C. PATRICK GRAY D.D.S. (OWNER)
- **Authorized official phone:** (810) 732-0200

## Contact information

- **Practice address:** 3515 COOLIDGE ROAD, SUITE C, EAST LANSING, MI 48823
- **Practice address phone:** (517) 332-2422
- **Mailing address:** 3515 COOLIDGE RD, SUITE C, EAST LANSING, MI 48823-8014
- **Mailing address phone:** (810) 230-3245
- **Mailing address fax:** (810) 230-3229

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 12257 | MI | Yes |

## Other

- **Enumeration date:** 12/09/2013
- **Last updated:** 02/08/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | PTAN7290590001 | PTAN | MI |