East Lake Dental Pllc
NPI #1104401645 in South Lyon, Michigan
Provider Information
- NPI Number
- 1104401645
- Entity Type
- Organization
- Organization Name
- East Lake Dental Pllc
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Mar 16, 2021
- Last Updated
- Mar 16, 2021
Practice Location
- Address
- 201 S LAFAYETTE ST
- City
- South Lyon
- State
- Michigan
- ZIP Code
- 48178-1405
- Phone
- (248) 437-4119
Authorized Official
- Name
- WILLIAM RYAN JENKINS, DDS
- Title
- OWNER DENTIST
- Phone
- (248) 321-9485
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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