| NPI | 1699410456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD HENDRICKS Credentialing 248-569-6304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223E0200X Dentist Endodontics |
| Enumeration Date | 2022-05-04 |
| Last Update Date | 2022-05-04 |