| NPI | 1366745119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MARIE OBRY Office Manager 248-651-4202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2010-12-17 |
| Last Update Date | 2018-11-02 |