| NPI | 1114906781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK STEVEN MACDONALD President Owner 313-563-2522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901014432) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2020-08-22 |