| NPI | 1962752725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL JOHN DERKSEN Member 517-712-8880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901019585) |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2012-09-19 |