| NPI | 1366597148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MICHAEL SUSHKO Executive Director 248-644-5735 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: MI 1810857) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2020-08-22 |