| NPI | 1114229911 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD G WOLFORD Owner 586-777-1331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 2901010985) |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2015-10-27 |