| NPI | 1932327707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL A. KRUSE President 616-656-4155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MI 2901015087) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-08-22 |