| NPI | 1548283559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM L ERICKSON Owner 616-977-5000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MI KE011553) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI KE011553) |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: MI KE011553) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2020-08-22 |