| NPI | 1558530477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORA LAZOVSKI Vice President 586-716-4890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901018006) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901018071) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2008-02-25 |