| NPI | 1316422066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN GROTH President, Owner 248-885-8247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2021-07-22 |