| NPI | 1720336696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY RUSSELL HUBBARD Dentist 517-332-2422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: MI 11821) |
| Enumeration Date | 2012-08-26 |
| Last Update Date | 2012-11-24 |