| NPI | 1770800559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM STEWARD Provider Relations Manager 315-454-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901020140) |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2010-05-03 |