Organization
MANISTIQUE DENTAL CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY DAVID LAFAYETTE DDS (PRESIDENT)
(906) 341-6132
Entity
Organization
Contact information
Practice address
115 N LAKE ST LOWR LEVEL, MANISTIQUE, MI 49854-1234
(906) 341-6132
(906) 341-3054
Mailing address
115 N LAKE ST LOWR LEVEL, MANISTIQUE, MI 49854-1234
(906) 341-6132
(906) 341-3054
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901016294
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558410902
—
MI
Enumeration date
04/22/2008
Last updated
04/22/2008
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