| NPI | 1649464850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY CLYDE HARVEY Owner 218-236-1322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN D10196) |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2007-08-30 |