| NPI | 1295898906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK EDGAR HARDWICK General Dentist 586-752-6586 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI 11564) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2020-08-22 |