Main Street Dental Pllc

NPI #1679215818 in Olivet, Michigan

Provider Information

NPI Number: 1679215818
Entity Type: Organization
Organization Name: Main Street Dental Pllc
Primary Specialty: Dentist
Enumeration Date: Apr 8, 2022
Last Updated: Apr 8, 2022

Practice Location

Address: 123 S MAIN ST
City: Olivet
State: Michigan
ZIP Code: 49076-9404
Phone: (269) 749-9477

Authorized Official

Name: LANA LEWIS, DDS
Title: MEMBER
Phone: (269) 749-9477

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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