| NPI | 1679855761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN NICOLE MOERDYKE Office Manager 616-241-5658 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI 16791) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2011-09-14 |