| NPI | 1417121732 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT ALLEN MORTIMER President 810-743-5131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901014445) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2015-07-15 |