| NPI | 1962648246 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OTTO KEVIN KLANOW Owner President 586-979-4700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901011910) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901011910) |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2008-12-17 |