| NPI | 1629371182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN BRIAN DAVIS CEO 248-851-5650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 017174) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MI 2902011884) |
| 124Q00000X Dental Hygienist | |
| Enumeration Date | 2010-12-06 |
| Last Update Date | 2010-12-06 |