| NPI | 1275914673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON C DOUBLESTEIN Co Owner 616-530-2200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901018806) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020644) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2019-10-09 |