| NPI | 1922293851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEGGY MCCALL Office Personel 616-940-2854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI 2901016791) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2007-09-13 |