| NPI | 1093819344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA HAGIE Office Manager 231-935-8461 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 014902) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 012813) |
| 1223G0001X Dentist, General Practice (Licence: MI 012865) | |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2022-12-29 |