| NPI | 1205844081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY DAVID SEVENER President 231-755-6515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI 17061) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2020-08-22 |