| NPI | 1033594411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRESHA KAYE YORTON Office Manager 810-445-9970 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901017170) |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2020-10-29 |