| NPI | 1366950248 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IRINA KRIVICHKIN General Manager 248-207-5218 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MI 2901021142) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 13301) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MI 2901021276) | |
| Enumeration Date | 2018-01-13 |
| Last Update Date | 2018-01-13 |