| NPI | 1700053634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARRY ALLEN MENTZEL President 586-772-1880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI M10005) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2008-05-09 |