| NPI | 1295164556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA L KIMBALL Dental Program Manager 616-392-3610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: MI 2902010638) |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2013-11-07 |