| NPI | 1790264299 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUDOLPH DELANO WHEATON Director/Administrator 810-308-5086 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2018-08-07 |