| NPI | 1508585654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDSAY JO SANFORD Dental Assistant/Front Desk 231-627-4301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2022-08-23 |