| NPI | 1922261783 |
|---|---|
| Doing Business As | LAKES ORAL AND MAXILLOFACIAL SURGERY PC |
| Entity Type | Organization |
| Authorized Contact | CYNTHIA LOUISE FETTER Front Office Supervisor 248-669-6600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MI jc07120) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2014-05-16 |