Healthcare Provider Details

I. General information

NPI: 1992631121
Provider Name (Legal Business Name): GREAT LAKES AIRWAY AND SLEEP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 N LILLEY RD STE D
CANTON MI
48187-3685
US

IV. Provider business mailing address

9254 MARLOWE AVE
PLYMOUTH MI
48170-4038
US

V. Phone/Fax

Practice location:
  • Phone: 734-335-0820
  • Fax:
Mailing address:
  • Phone: 734-679-8898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: HALEY LAWRENCE-PUMMILL
Title or Position: DENTIST
Credential: DDS
Phone: 734-679-8898