| NPI | 1134564537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALBERT WESLEY Owner 248-270-5358 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901015295) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2019-08-20 |