Individual
LONNY E ZIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
2140 LAKE MICHIGAN DR NW, GRAND RAPIDS, MI 49504-4785
(616) 791-9600
Mailing address
2140 LAKE MICHIGAN DR NW, GRAND RAPIDS, MI 49504-4785
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2901009665
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
096650
BCBSD
MI
01
—
0D111530
BCBSM
MI
Enumeration date
10/04/2006
Last updated
07/13/2007
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