| NPI | 1992816177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE L STOUT Front Desk Supervisor 231-737-0001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901011382) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901007277) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |