| NPI | 1871706663 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN F. SIVERTSON President 734-522-7313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI 2901010031) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2020-08-22 |