| NPI | 1013118330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK GRYTZELIUS Dentist 734-591-4145 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 11295) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2020-08-22 |