| NPI | 1144083031 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VU KONG Owner 517-414-9468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-02-02 |
| Last Update Date | 2024-09-20 |