Individual
GREGORY DAVID LA FAYETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
115 N LAKE ST, LOWER LEVEL, MANISTIQUE, MI 49854-1234
(906) 341-6132
(906) 341-3054
Mailing address
115 N LAKE ST, LOWER LEVEL, MANISTIQUE, MI 49854-1234
(906) 341-6132
(906) 341-3054
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901016294
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2952112
—
MI
01
—
D802465
BLUE CROSS BLUE SHIELD
MI
Enumeration date
01/08/2007
Last updated
07/08/2007
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