| NPI | 1083129910 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW RYAN VANDERLAAN Owner/Dentist 616-455-7310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901020014) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021039) |
| Enumeration Date | 2017-12-14 |
| Last Update Date | 2017-12-14 |