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Organization

GREAT LAKES FAMILY DENTAL GROUP-LIVONIA, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. C PATRICK GRAY D.D.S. (OWNER/PRESIDENT)
(810) 732-0200
Entity
Organization

Contact information

Practice address
16160 MIDDLEBELT RD, LIVONIA, MI 48154-3338
(734) 261-9696
Mailing address
G3222 BEECHER RD, FLINT, MI 48532-3614
(810) 230-3245
(810) 230-3229

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
122300000X
MI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
1223S0112X
MI

Other

Enumeration date
02/15/2010
Last updated
02/15/2010
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