| NPI | 1730168360 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID MICHAEL CLARK Vice President 248-855-4850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI 13431) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 13313) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2020-08-22 |