| NPI | 1396276333 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW JAMES BALAZE Dentist/Owner 517-787-5055 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901020967) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2019-08-07 |