Organization
GRAND LAKE FAMILY DENTISTRY, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRAVIS DUANE LUTZ DDS (PRESIDENT)
(419) 586-1615
Entity
Organization
Contact information
Practice address
800 E WAYNE ST, CELINA, OH 45822-1359
(419) 586-1615
(419) 586-1616
Mailing address
800 E WAYNE ST, PO BOX 316, CELINA, OH 45822-1359
(419) 586-1615
(419) 586-1616
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30.020826
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06131
PARAMOUNT
—
05
—
2057965
—
OH
01
—
9182631
DENTAQUEST
—
Enumeration date
03/23/2007
Last updated
05/20/2025
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