| NPI | 1376908392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD M WITKOW President 810-659-1721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2015-12-17 |
| Last Update Date | 2022-04-25 |