Grand Lake Family Dentistry Travis D Lutz Dds- Rockford Ltd

NPI #1366044158 in Rockford, Ohio

Provider Information

NPI Number: 1366044158
Entity Type: Organization
Organization Name: Grand Lake Family Dentistry Travis D Lutz Dds- Rockford Ltd
Primary Specialty: Dentist - General Practice
Enumeration Date: Nov 16, 2020
Last Updated: Nov 16, 2020

Practice Location

Address: 160 E. WALNUT ST.
City: Rockford
State: Ohio
ZIP Code: 45882
Phone: (419) 363-3537

Authorized Official

Name: DR. TRAVIS LUTZ, DDS
Title: OWNER/DENTIST
Phone: (419) 305-9983

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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