| NPI | 1336274323 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID JOHN WADAS Sole Member 269-323-1802 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MI 2901017839) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2020-08-22 |