| NPI | 1124196183 |
|---|---|
| Doing Business As | GREAT LAKES DENTAL EXCELLENCE |
| Entity Type | Organization |
| Authorized Contact | MARY BETH HEGEDUS Administrator 231-799-0404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 08841) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2020-08-22 |