Provider Demographics
NPI:1396812996
Name:IMPLANT DENTISTRY OF GREATER LANSING
Entity type:Organization
Organization Name:IMPLANT DENTISTRY OF GREATER LANSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-484-0329
Mailing Address - Street 1:900 W OTTAWA ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48915-1702
Mailing Address - Country:US
Mailing Address - Phone:517-484-0329
Mailing Address - Fax:
Practice Address - Street 1:900 W OTTAWA ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1702
Practice Address - Country:US
Practice Address - Phone:517-484-0329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI129591223G0001X
MI177681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty