| NPI | 1740393719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY VAN AMEYEDE Owner 586-323-1600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 10374) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2020-08-22 |