# HART FAMILY DENTISTRY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Hart Lake Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902423239
- **Authorized official:** DR. GRANT KURTIS GILLISH DDS (DENTIST/OWNER)
- **Authorized official phone:** (231) 873-4025

## Contact information

- **Practice address:** 110 S DRYDEN ST, HART, MI 49420-1105
- **Practice address phone:** (231) 873-4025
- **Mailing address:** 110 S DRYDEN ST, HART, MI 49420-1105
- **Mailing address phone:** (231) 873-4025

## Taxonomy

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

## Other

- **Enumeration date:** 07/02/2020
- **Last updated:** 07/23/2020