| NPI | 1689119414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB S MILLER President 616-901-9148 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI L2901020673) |
| Enumeration Date | 2017-01-03 |
| Last Update Date | 2017-01-03 |