| NPI | 1588722300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE MAYO Manager 517-748-5500 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: MI 2901008781) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2022-02-10 |