| NPI | 1013363761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE HENDRIE Office Manager 231-865-6945 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 18853) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 29010020645) |
| 1223G0001X Dentist, General Practice (Licence: MI 5315070576) | |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2016-05-12 |