| NPI | 1043688013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY CHARLES BANDEED Owner 269-963-4118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MI L857187) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI L2535752) |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2015-09-09 |