| NPI | 1225478514 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA RENAE DAVIS Owner/Member 734-995-5191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901017453) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2013-07-01 |