| NPI | 1164642906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY ROGERS SMITH Owner 269-381-7770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 012321) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2020-08-22 |