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Organization

GREAT LAKES BAY ORTHODONTICS, PLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANDREW GRILLO DDS, MSD (ORTHODONTIST)
(989) 600-8037
Entity
Organization

Contact information

Practice address
200 NORTHGATE DR, MIDLAND, MI 48640-7344
(989) 631-1334
Mailing address
200 NORTHGATE DR, MIDLAND, MI 48640-7344
(989) 631-1334

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary

Other

Enumeration date
10/24/2019
Last updated
10/24/2019
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