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

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

## Provider details

- **NPI number:** 1801345061
- **Authorized official:** MRS. PATRICIA J. HART (CORPORATE MANAGER)
- **Authorized official phone:** (810) 625-2860

## Contact information

- **Practice address:** 21635 RYAN RD, WARREN, MI 48091-2788
- **Practice address phone:** (810) 230-2345
- **Practice address fax:** (810) 230-3229
- **Mailing address:** G3222 BEECHER RD, FLINT, MI 48532-3614

## Taxonomy

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

## Other

- **Enumeration date:** 09/29/2016
- **Last updated:** 09/29/2016