| NPI | 1205030277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALLACE L WALKER Dentist 313-340-9293 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 12881) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2020-08-22 |