Provider Demographics
NPI:1669544888
Name:PROGRESSIVE PERIODONTICS PC
Entity type:Organization
Organization Name:PROGRESSIVE PERIODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:KAZOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PHD
Authorized Official - Phone:517-372-7347
Mailing Address - Street 1:2412 LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3618
Mailing Address - Country:US
Mailing Address - Phone:517-372-7347
Mailing Address - Fax:517-372-7349
Practice Address - Street 1:2412 LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3618
Practice Address - Country:US
Practice Address - Phone:517-372-7347
Practice Address - Fax:517-372-7349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010172821223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty