| NPI | 1841648987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA M KIRCHNER Credentialing Manager 586-915-0107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901021511) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2016-05-31 |