| NPI | 1760887020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA MARIE KIRCHNER Insurance Manager 586-915-0107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901021011) |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2015-05-12 |