# L'ANSE FAMILY DENTISTRY PC

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

## Provider details

- **NPI number:** 1801176169
- **Authorized official:** MARK G SUMMERSETT DDS (DENTIST)
- **Authorized official phone:** (906) 524-6420

## Contact information

- **Practice address:** 15647 NORDSTROM ST, LANSE, MI 49946-8439
- **Practice address phone:** (906) 524-6420
- **Practice address fax:** (906) 524-6821
- **Mailing address:** PO BOX 9, 15647 NORDSTROM ST, LANSE, MI 49946-0009
- **Mailing address phone:** (906) 524-6420
- **Mailing address fax:** (906) 524-6821

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2901013208 | MI | Yes |
| 122300000X | Dentist | 2901020319 | MI | — |

## Other

- **Enumeration date:** 08/18/2011
- **Last updated:** 09/01/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1778884 | — | MI |