| NPI | 1083624662 |
|---|---|
| Other Name | DENTAL OFFICE |
| Entity Type | Organization |
| Authorized Contact | DOUGLAS A BLEYENBURG President 616-392-2302 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 16773) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2020-08-22 |