| NPI | 1972794352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN P. WEINS Owner 248-855-6655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 2901010565) |
| Additional Taxonomies | 122300000X Dentist |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MI 2901010587) | |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2017-05-12 |