| NPI | 1790110005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN DAVID JAY President 734-241-3399 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MI 20147) |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2013-09-05 |