| NPI | 1962416875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN MARTIN MCCOY Owner 517-782-2439 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MI 2901017848) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2020-08-22 |