| NPI | 1487375218 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXIS FAIRFIELD Insurance Coordinator 231-220-0500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2022-09-09 |
| Last Update Date | 2023-08-01 |