| NPI | 1790199461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRASHANTH RAVI Director 231-392-2500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: TX 29763) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2014-08-06 |