| NPI | 1104993484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA LYNN BAUER MONDRAGON President Owner 517-676-1091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901015785) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2020-08-22 |