| NPI | 1578002812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN MICHAEL ETHERTON Regional Manager 616-780-6879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI 2901021083) |
| Enumeration Date | 2017-02-20 |
| Last Update Date | 2017-02-20 |