Organization
EAST LAKE DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM RYAN JENKINS DDS (OWNER DENTIST)
(248) 321-9485
Entity
Organization
Contact information
Practice address
201 S LAFAYETTE ST, SOUTH LYON, MI 48178-1405
(248) 437-4119
Mailing address
3542 OAKSHIRE AVE, BERKLEY, MI 48072-3411
(248) 321-9485
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/16/2021
Last updated
03/16/2021
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