Healthcare Provider Details

I. General information

NPI: 1649650326
Provider Name (Legal Business Name): DYRAS DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 09/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S GRAND AVE
LANSING MI
48933-2406
US

IV. Provider business mailing address

601 S GRAND AVE
LANSING MI
48933-2406
US

V. Phone/Fax

Practice location:
  • Phone: 517-485-1900
  • Fax:
Mailing address:
  • Phone: 517-485-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901019987
License Number StateMI

VIII. Authorized Official

Name: LAURA DYRAS
Title or Position: DENTIST
Credential: DDS
Phone: 517-485-1900