| NPI | 1912000977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK C SHADER President 248-625-9444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 11126) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2020-08-22 |