| NPI | 1053458604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK T. BURYE Owner 231-733-1571 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI B7708N) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2020-06-12 |