| NPI | 1376787762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK F. MCGOVERN Partner 906-228-9594 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI MM015901) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI MS19101) |
| 1223G0001X Dentist General Practice (Licence: MI RP010017) | |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2009-04-29 |