# MAIN STREET DENTAL PLLC

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

## Provider details

- **NPI number:** 1679215818
- **Authorized official:** LANA LEWIS DDS (MEMBER)
- **Authorized official phone:** (269) 749-9477

## Contact information

- **Practice address:** 123 S MAIN ST, OLIVET, MI 49076-9404
- **Practice address phone:** (269) 749-9477
- **Practice address fax:** (269) 749-9810
- **Mailing address:** PO BOX 536, OLIVET, MI 49076-0536
- **Mailing address phone:** (269) 749-9477

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 04/08/2022
- **Last updated:** 04/08/2022