| NPI | 1255422143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA GALONSKA Vice President 989-759-6464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2019-02-19 |