Healthcare Provider Details

I. General information

NPI: 1598034829
Provider Name (Legal Business Name): LAKEPOINTE ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22006 GREATER MACK AVE
SAINT CLAIR SHORES MI
48080-2307
US

IV. Provider business mailing address

22006 GREATER MACK AVE
SAINT CLAIR SHORES MI
48080-2307
US

V. Phone/Fax

Practice location:
  • Phone: 586-772-6090
  • Fax: 586-772-0621
Mailing address:
  • Phone: 586-772-6090
  • Fax: 586-772-0621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM LOUIS KRIEG
Title or Position: ORTHODONTIST
Credential: D.D.S., M.S.
Phone: 586-772-6090