| NPI | 1942281480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH MICHAEL ELLIS Owner/President 616-949-7290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901014927) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2013-02-21 |