| NPI | 1336171800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER D MAZZOLA Owner 734-657-1854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901019122) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 12127) |
| 1223G0001X Dentist, General Practice (Licence: MI 12516) | |
| 1223G0001X Dentist, General Practice (Licence: MI 13833) | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2022-03-23 |