| NPI | 1770848129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA HORSCH Manager 586-757-7540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 15917) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2451596) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: MI 15917) | |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2014-09-09 |