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 |