| NPI | 1114404738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISA DORETTE HOPE BURRELL Office Manager / Administrator 586-248-4500 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2021-05-10 |