| NPI | 1194962753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY MISCH Manager 734-975-1743 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI 2901019093) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MI 2901018946) |
| Enumeration Date | 2009-01-19 |
| Last Update Date | 2009-01-19 |