| NPI | 1497409411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISEANE KOGA Orthodontist 269-985-8168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2022-02-08 |