| NPI | 1013648278 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID C HAVENS Member 586-242-6789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-06-20 |
| Last Update Date | 2022-06-20 |