| NPI | 1316048077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAITH TOBIN JACOBSON Dentist 734-427-9300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901016783) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901017710) |
| 122300000X Dentist (Licence: MI 2901018923) | |
| 124Q00000X Dental Hygienist (Licence: MI 2902006805) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-08-22 |