| NPI | 1164672044 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY C VANDEREST Owner 810-798-3941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901014473) |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2008-10-20 |