Organization
MARK J LODGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA SMITH (OFFICE MANAGER)
(810) 694-8073
Entity
Organization
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
—
—
Other
Enumeration date
08/22/2023
Last updated
08/22/2023
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