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Organization
LAKE ODESSA DENTAL, PLLC
Active
Organization
LAKE ODESSA DENTAL, PLLC
Active
Other names
Lake Odessa Dental Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL JOSEPH CRETE DDS (MEMBER)
(616) 560-3625
Entity
Organization
Contact information
Practice address
1032 4TH AVE, LAKE ODESSA, MI 48849-1004
(616) 374-8828
(616) 374-7934
Mailing address
2101 SAN LU RAE DR SE, GRAND RAPIDS, MI 49506-3425
(616) 560-3625
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/30/2018
Last updated
04/30/2018
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