| NPI | 1679981203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN-NIKKO LEE Secretary 989-385-0833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 27888) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 27923) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2014-07-28 |