# DENTISTRY ETC

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

## Provider details

- **NPI number:** 1447405261
- **Authorized official:** JILL LEACH (OFFICE MANAGER)
- **Authorized official phone:** (810) 695-4300

## Contact information

- **Practice address:** 4025 E HILL RD, GRAND BLANC, MI 48439-7942
- **Practice address phone:** (810) 695-4300
- **Practice address fax:** (810) 695-2309
- **Mailing address:** 4025 E HILL RD, GRAND BLANC, MI 48439-7942
- **Mailing address phone:** (810) 695-4300
- **Mailing address fax:** (810) 695-2309

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 12818 | MI | Yes |

## Other

- **Enumeration date:** 11/20/2008
- **Last updated:** 11/20/2008