| NPI | 1043095771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY POPE Project Manager 616-283-8867 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2023-08-30 |