| NPI | 1083884092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANFORD JAY NITZKIN Dds 734-427-7555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI 14658) |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2008-03-05 |