| NPI | 1396825998 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK EDWARD KOONMEN Owner/President 810-732-0640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 13770) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2008-03-24 |