| NPI | 1235370834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK L O'DELL Dentist 989-624-9381 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 11334) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019315) |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2009-03-12 |