| NPI | 1073689899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRABHA R RAJU Owner Doctor 810-715-3368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 15924) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2020-08-22 |