| NPI | 1962830794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY BURGESS MULDE4R Dentist 616-458-0631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2013-10-14 |
| Last Update Date | 2013-10-14 |