| NPI | 1316158157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINALD BERNARD JEWELL President 313-839-8888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 17336) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-08-22 |