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1104067644
SOUTHFIELD DENTAL PLLC
SOUTHFIELD, MI
NPI
1104067644
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Entity Type
Organization
Authorized Contact
RAYMOND A FORTSON
Member
248-569-6722
Organization Subpart ?
No
Primary Taxonomy
122300000X Dentist
(Licence: MI 2901014077)
Enumeration Date
2009-03-12
Last Update Date
2009-03-12
Business Address
SOUTHFIELD DENTAL PLLC
17600 W 12 MILE RD SUITE 3
SOUTHFIELD, MI 48076-1910
Phone number: 248-569-6722
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Mailing Address
SOUTHFIELD DENTAL PLLC
17600 W 12 MILE RD SUITE 3
SOUTHFIELD, MI 48076-1910
Phone number: 248-569-6722
Copy
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