| NPI | 1245649789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDA DAGHER Owner/Manager 313-945-9977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| 124Q00000X Dental Hygienist | |
| 126800000X Dental Assistant | |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2014-08-08 |