| NPI | 1639397615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON MARIE VISSCHER-WORST Office Manager 616-363-1136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 16615) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 10428) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |