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Organization
VMLP AH PLC
Active
Organization
VMLP AH PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BERTOLLINI (PRS)
(866) 273-8204
Entity
Organization
Contact information
Practice address
4929 SOUTH BALDWIN RD, STE 104, LAKE ORION, MI 48359
(248) 221-1743
(248) 393-3228
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(866) 273-8204
(315) 410-5531
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
20509
MI
Other
Enumeration date
04/21/2016
Last updated
04/21/2016
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