| NPI | 1417072612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORIS J ALLEN Director 734-998-9640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223P0300X Dentist, Periodontics | |
| 124Q00000X Dental Hygienist | |
| 126800000X Dental Assistant | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2025-09-11 |