| 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 |