Provider Demographics
NPI:1649095720
Name:LAINGSBURG FAMILY DENTAL
Entity type:Organization
Organization Name:LAINGSBURG FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CROWELL-POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-410-3772
Mailing Address - Street 1:231 E GRAND RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-8601
Mailing Address - Country:US
Mailing Address - Phone:248-410-3772
Mailing Address - Fax:517-919-6070
Practice Address - Street 1:231 E GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:LAINGSBURG
Practice Address - State:MI
Practice Address - Zip Code:48848-8601
Practice Address - Country:US
Practice Address - Phone:248-410-3772
Practice Address - Fax:517-919-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental