| NPI | 1063881407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M MUSGRAVE Sole Proprietor 231-882-9683 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI 2901021135) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2015-09-16 |