| NPI | 1225449689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY WURTZEL Office Manager 734-971-2675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901012866) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020016) |
| 122300000X Dentist (Licence: MI 2901020455) | |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2014-05-19 |