| NPI | 1073909297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK WIERENGA Orthodontist 616-301-8900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: MI 2901020872) |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2016-04-30 |