| NPI | 1235101841 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY L ROESER Secretary 248-620-6800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 8615) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 9453) |
| 122300000X Dentist (Licence: MI 16742) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2020-08-22 |