| NPI | 1699176438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB BRADY THAYER President 313-468-2162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901019145) |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2014-09-11 |