| NPI | 1801017173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTHA VEGA-CRIST Owner 248-969-4840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901016889) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |