Healthcare Provider Details

I. General information

NPI: 1013054253
Provider Name (Legal Business Name): COLUMBIAVILLE FAMILY DENTISTRY, STANLEY K. LORANG, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4469 5TH ST
COLUMBIAVILLE MI
48421-9368
US

IV. Provider business mailing address

PO BOX 70
COLUMBIAVILLE MI
48421-0070
US

V. Phone/Fax

Practice location:
  • Phone: 810-793-6255
  • Fax: 810-793-5663
Mailing address:
  • Phone: 810-793-6255
  • Fax: 810-793-5663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13923
License Number StateMI

VIII. Authorized Official

Name: DR. STANLEY K. LORANG
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 810-793-6255