| NPI | 1306014816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES W CLARK Dentist 734-971-3368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901010113) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MI 2901018096) |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2008-02-19 |