| NPI | 1629445986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY VORE Practice Administrator 734-243-9160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2015-08-21 |
| Last Update Date | 2019-07-31 |