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

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

## Provider details

- **NPI number:** 1437557345
- **Authorized official:** MRS. PATRICIA J. HART (CORPORATE MANAGER)
- **Authorized official phone:** (810) 625-2860

## Contact information

- **Practice address:** 1003 W. MCGALLIARD ROAD, MUNCIE, IN 47303
- **Practice address phone:** (765) 288-1307
- **Mailing address:** 1003 W. MCGALLIARD ROAD, MUNCIE, IN 47303
- **Mailing address phone:** (765) 288-1307

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12012248A | IN | Yes |

## Other

- **Enumeration date:** 12/09/2014
- **Last updated:** 12/09/2014