| NPI | 1265863021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN DAVID MAYLATH President 248-642-5020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 14767) |
| Enumeration Date | 2013-12-04 |
| Last Update Date | 2013-12-04 |