| NPI | 1023719960 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAYHANA EBRAHIM Dentist 810-603-7887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2023-03-16 |
| Last Update Date | 2023-03-16 |