Healthcare Provider Details

I. General information

NPI: 1548459415
Provider Name (Legal Business Name): STANLEY K LORANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
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:
Title or Position:
Credential:
Phone: