| NPI | 1710303599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN SHANE POUND Member 517-787-9630 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 19773) |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2014-03-17 |