| NPI | 1891194379 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP GLENN MONROY Owner 810-985-9660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901018671) |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2014-08-20 |