| NPI | 1790799617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NEIL WAYNE THOMAS Owner 810-227-5136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 10577) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 12544) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2020-08-22 |