| NPI | 1699141101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA M KIRCHNER Credentialing Manager 586-915-0107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901017136) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2015-08-19 |