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1609906791
MARK J LODGE
GRAND BLANC, MI
NPI
1609906791
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1223G0001X Dentist, General Practice
(Licence: MI 2901015757)
Enumeration Date
2007-03-07
Last Update Date
2007-07-08
Business Address
-- MARK J LODGE DDS
134 HIGH ST
GRAND BLANC, MI 48439-1335
Phone number: 810-694-8073
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Mailing Address
-- MARK J LODGE DDS
134 HIGH ST
GRAND BLANC, MI 48439-1335
Phone number: 810-694-8073
Copy
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