| NPI | 1700064847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY VAN AMEYDE Oral Surgeon 586-323-1600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 10374) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2008-01-31 |