| NPI | 1255669818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE KOHN Medical Director 231-737-1335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2009-11-19 |
| Last Update Date | 2011-06-09 |