| Grand Lake Family Dentistry, Ltd. | |
|
800 E Wayne St Celina OH 45822-1359 | |
| (419) 586-1615 | |
| (419) 586-1616 |
| Full Name | Grand Lake Family Dentistry, Ltd. |
|---|---|
| Speciality | Dentist |
| Location | 800 E Wayne St, Celina, Ohio |
| Authorized Official Name and Position | Travis Duane Lutz (PRESIDENT) |
| Authorized Official Contact | 4195861615 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Lake Family Dentistry, Ltd. 800 E Wayne St Po Box 316 Celina OH 45822-1359 Ph: (419) 586-1615 | Grand Lake Family Dentistry, Ltd. 800 E Wayne St Celina OH 45822-1359 Ph: (419) 586-1615 |
| NPI Number | 1952428310 |
|---|---|
| Provider Enumeration Date | 03/23/2007 |
| Last Update Date | 12/20/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952428310 | NPI | - | NPPES |
| 9182631 | Other | DENTAQUEST | |
| 2057965 | Medicaid | OH | |
| 06131 | Other | PARAMOUNT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 30.020826 (Ohio) | Primary |
Dentistry For You, Forsthoefel And Schleucher, Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 136 N. Enterprise St., Celina, OH 45822 Phone: 419-586-1661 Fax: 419-584-0424 | |
Willmann Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1304 Meadowview Dr, Celina, OH 45822 Phone: 419-586-4738 Fax: 419-586-5222 | |
William H Wiley Dds Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 405 Myers Rd, Celina, OH 45822 Phone: 419-586-4738 Fax: 419-586-5222 |