# GREAT LAKES FAMILY DENTAL GROUP - GRAND BLANC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Great Lakes Family Dental Group - Flint
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720323173
- **Authorized official:** DR. CLARENCE PATRICK GRAY DDS (OWNER/PRESIDENT)
- **Authorized official phone:** (810) 732-0200

## Contact information

- **Practice address:** 8542 HOLLY ROAD, GRAND BLANC, MI 48439
- **Practice address phone:** (810) 603-7887
- **Practice address fax:** (810) 720-1306
- **Mailing address:** 8542 HOLLY ROAD, GRAND BLANC, MI 48439
- **Mailing address phone:** (810) 603-7887
- **Mailing address fax:** (810) 720-1306

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2901012257 | MI | Yes |
| 1223G0001X | General Practice Dentistry | — | — | — |

## Other

- **Enumeration date:** 12/11/2012
- **Last updated:** 06/13/2018