| NPI | 1801291315 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERIDITH L HALL Member 734-930-4022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901017411) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301096549) |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2014-10-27 |