| NPI | 1255846754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLYTHE A O'DONNELL Dentist 231-723-6512 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MI 18268) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: MI 11462) |
| Enumeration Date | 2017-12-06 |
| Last Update Date | 2017-12-06 |