| NPI | 1194081273 |
|---|---|
| Doing Business As | FORT STREET DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | SHAWN M LAVOIE Insurance Biller 3139-288-5555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901016290) |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2012-04-03 |