| NPI | 1174239420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY BARONE Front Office 517-484-8910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2023-02-20 |