=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013054253
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLUMBIAVILLE FAMILY DENTISTRY, STANLEY K. LORANG, DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4469 5TH ST
-----------------------------------------------------
City | COLUMBIAVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48421-9368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-793-6255
-----------------------------------------------------
Fax | 810-793-5663
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 70
-----------------------------------------------------
City | COLUMBIAVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48421-0070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-793-6255
-----------------------------------------------------
Fax | 810-793-5663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STANLEY K. LORANG
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 810-793-6255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 13923
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------