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Organization
PERIODONTAL SPECIALISTS OF GRAND BLANC PC
Active
Organization
PERIODONTAL SPECIALISTS OF GRAND BLANC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KELLY LYNN COGGINS (BUSINESS OFFICE ASST.)
(810) 695-6444
Entity
Organization
Contact information
Practice address
8185 HOLLY RD, SUITE19, GRAND BLANC, MI 48439-2444
(810) 695-6444
Mailing address
8185 HOLLY RD, SUITE19, GRAND BLANC, MI 48439-2444
(810) 695-6444
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
16909
MI
Other
Enumeration date
01/24/2008
Last updated
01/24/2008
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