| NPI | 1346853702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHALEAH NORRELL Receptionist 313-278-4470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2024-04-19 |