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

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

## Provider details

- **NPI number:** 1497077630
- **Authorized official:** DR. C PATRICK GRAY D.D.S. (OWNER/PRESIDENT)
- **Authorized official phone:** (810) 732-0200

## Contact information

- **Practice address:** 16160 MIDDLEBELT RD, LIVONIA, MI 48154-3338
- **Practice address phone:** (734) 261-9696
- **Mailing address:** G3222 BEECHER RD, FLINT, MI 48532-3614
- **Mailing address phone:** (810) 230-3245
- **Mailing address fax:** (810) 230-3229

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 122300000X | MI | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | MI | — |

## Other

- **Enumeration date:** 02/15/2010
- **Last updated:** 02/15/2010