| NPI | 1851934236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT A. WATTERSON Owner/Member 517-206-1445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-10-18 |
| Last Update Date | 2019-10-18 |