| NPI | 1487068508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATINA JACKSON Office Manager 810-736-1500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901020598) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2014-06-17 |