| NPI | 1124540240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOESPH VINCENT MAURO Owner 517-272-0886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: MI JM012412) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2022-07-21 |