Organization
GREAT LAKES FAMILY DENTAL GROUP-LANSING, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. C. PATRICK GRAY D.D.S. (OWNER)
(810) 732-0200
Entity
Organization
Contact information
Practice address
3515 COOLIDGE ROAD, SUITE C, EAST LANSING, MI 48823
(517) 332-2422
Mailing address
3515 COOLIDGE RD, SUITE C, EAST LANSING, MI 48823-8014
(810) 230-3245
(810) 230-3229
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12257
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTAN7290590001
PTAN
MI
Enumeration date
12/09/2013
Last updated
02/08/2017
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