| NPI | 1326414426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY MANSOUR Manager 248-242-6600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 13614) |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2021-05-21 |