| NPI | 1093872525 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA LYNN VERMILLION Office Manager 517-336-9880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI 17100) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2023-01-31 |