| NPI | 1467557413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARLENE S PRUSS Office Manager 517-263-3400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901017644) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2020-08-22 |