Individual
MARK J LODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
134 HIGH ST, GRAND BLANC, MI 48439-1335
(810) 694-8073
(810) 694-1764
Mailing address
134 HIGH ST, GRAND BLANC, MI 48439-1335
(810) 694-8073
(810) 694-1764
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901015757
MI
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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