| NPI | 1164299525 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAZMYN RAGLAND Executive Director 517-513-4923 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| Enumeration Date | 2023-12-06 |
| Last Update Date | 2023-12-15 |