Organization
LAKE CITY FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MITCH TY CARPENTER-THOMPSON DMD (OWNER/DENTIST)
(231) 839-2630
Entity
Organization
Contact information
Practice address
213 S CANAL ST, LAKE CITY, MI 49651-8865
(231) 839-2630
(231) 839-5751
Mailing address
213 S CANAL ST, PO BOX 719, LAKE CITY, MI 49651
(231) 839-2630
(231) 839-5751
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
600446
STATE LICENSE
MI
Enumeration date
05/21/2021
Last updated
05/21/2021
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