| NPI | 1295468411 |
|---|---|
| Doing Business As | WOLVERINE FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | KEVIN WIECZERZA Owner 518-320-6912 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-07-05 |
| Last Update Date | 2022-07-05 |