| NPI | 1255508800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GHANEM M. GHANNAM Sole Owner 313-842-3770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2024-08-29 |