| NPI | 1710093992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA MAE WIGGINS Owner Sole Member 906-225-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: MI 2901016962) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2024-03-03 |