| NPI | 1215483284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT LEWIS EGGLESTON Owner 616-538-3060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901016314) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021476) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2016-08-30 |