| NPI | 1205815628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL G COSTELLO Manager 248-543-7070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI 014041) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2020-08-22 |