| NPI | 1003903741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA CROUCH Office Mananger 231-946-0070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2022-07-21 |