| NPI | 1578759437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY CHARLES MOORE President 616-285-9509 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901010163) |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2007-09-24 |