| NPI | 1326179292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY T HUISMAN Owner 616-396-5919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 18263) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 10141) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2020-08-22 |