| NPI | 1639103641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA LYNN MCINTOSH Co Owner 734-769-2708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 16084) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 15619) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2020-08-22 |