| NPI | 1326381112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA MARIE KIRCHNER Credentialing Manager 586-873-4483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901010299) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2017-06-23 |