Organization
PERIODONTAL SPECIALISTS OF GRAND BLANC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KELLY LYNN COGGINS (BUSINESS OFFICE ASST.)
(810) 695-6444
Entity
Organization
Contact information
Practice address
8185 HOLLY RD, SUITE19, GRAND BLANC, MI 48439-2444
(810) 695-6444
Mailing address
8185 HOLLY RD, SUITE19, GRAND BLANC, MI 48439-2444
(810) 695-6444
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
16909
MI
Other
Enumeration date
01/24/2008
Last updated
01/24/2008
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