| NPI | 1235375296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRK E FABER Chair Person 616-754-3511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 10419) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901010419) |
| Enumeration Date | 2008-12-22 |
| Last Update Date | 2009-01-07 |