| NPI | 1548443294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY H LEWIS Office 269-965-1339 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 11052) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 14976) |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2007-12-17 |