| NPI | 1255880100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN BUCCELLATO Dentist/CEO 586-531-8722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 10225) |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2016-10-25 |