| NPI | 1003229659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN A WIEDEMER Member 616-455-4108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901019234) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019908) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2014-06-10 |