Healthcare Provider Details

I. General information

NPI: 1285753046
Provider Name (Legal Business Name): CHARLOTTE M. CORTIS, DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 E MOUNT HOPE AVE
LANSING MI
48910-1916
US

IV. Provider business mailing address

2805 E MOUNT HOPE AVE
LANSING MI
48910-1916
US

V. Phone/Fax

Practice location:
  • Phone: 517-484-5811
  • Fax: 517-484-5873
Mailing address:
  • Phone: 517-484-5811
  • Fax: 517-484-5873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLOTTE MARIE CORTIS
Title or Position: PRESIDENT
Credential: DDS
Phone: 517-484-5811