| NPI | 1841620655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN J PETERSBURG President 517-223-8545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901010174) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901017224) |
| 122300000X Dentist (Licence: MI 2901020477) | |
| Enumeration Date | 2013-11-14 |
| Last Update Date | 2013-11-14 |