| NPI | 1376152504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL NOTTEN Office Manager 517-787-5367 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 305S00000X Point of Service |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2021-01-25 |