| NPI | 1699797662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON MATTHEW JACOBSON President 989-754-7500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901009423) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2020-08-22 |