| NPI | 1841365624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID R BOLLA CEO 810-982-9821 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 014392) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 12328) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2017-05-10 |