| NPI | 1063796456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN EDWARD ANDERSON Sole Member 906-485-5575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MI 2901019979) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2011-10-04 |