| NPI | 1306463286 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI GORLITZ Contracting & Credentialing Manager 248-505-9977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics |
| Enumeration Date | 2020-06-26 |
| Last Update Date | 2020-06-26 |