| NPI | 1619036613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY ALLEN BURAU Co Owner 810-694-8244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901015751) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901015019) |
| 122300000X Dentist (Licence: MI 2901017041) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2020-08-22 |