| NPI | 1417179466 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY E JOHNSON-ROBINSON Administrator 800-362-7645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 292200000X Dental Laboratory (Licence: MI 2901011576) |
| Additional Taxonomies | 292200000X Dental Laboratory (Licence: MI 2901015328) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2010-10-07 |