| NPI | 1760247480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KALEB C THOMPSON Owner 248-513-0259 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2024-02-28 |