| NPI | 1659778348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA MARIE KIRCHNER Credentialing Manager 586-915-0107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901018508) |
| Enumeration Date | 2014-11-25 |
| Last Update Date | 2014-11-25 |