| NPI | 1720323173 |
|---|---|
| Former Legal Business Name | GREAT LAKES FAMILY DENTAL GROUP - FLINT |
| Entity Type | Organization |
| Authorized Contact | CLARENCE PATRICK GRAY Owner/President 810-732-0200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901012257) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2012-12-11 |
| Last Update Date | 2018-06-13 |