| NPI | 1780861484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY LYNN COGGINS Business Office Asst. 810-695-6444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI 16909) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2008-01-24 |