Organization
GREAT LAKES FAMILY DENTAL GROUP-ST. JOSEPH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA J. HART (CORPORATE MANAGER)
(810) 625-2860
Entity
Organization
Contact information
Practice address
2525 S CLEVELAND AVE, SAINT JOSEPH, MI 49085-2649
(810) 625-2860
Mailing address
2525 S CLEVELAND AVE, SAINT JOSEPH, MI 49085-2649
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
07/13/2016
Last updated
07/13/2016
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