NPI | 1265887210 |
---|---|
Doing Business As | KOALA CENTER FOR SLEEP & TMJ DISORDERS MI-1 |
Entity Type | Organization |
Authorized Contact | BRENT JACKSON Owner 810-664-4641 |
Organization Subpart ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MI 2901021258) |
Additional Taxonomies | 122300000X Dentist (Licence: MI 2901009946) |
Enumeration Date | 2016-04-27 |
Last Update Date | 2016-04-27 |