| NPI | 1164820593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA RENEE TREECE Office Manager 734-242-8885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI 2901011208) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 2901019934) |
| 1223G0001X Dentist General Practice (Licence: MI 2901019893) | |
| Enumeration Date | 2014-12-17 |
| Last Update Date | 2014-12-17 |