| NPI | 1053523548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA L. FOGLE Owner 616-784-5993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MI 2901016682) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-08-22 |