| NPI | 1457188955 |
|---|---|
| Doing Business As | DESTINY DENTAL OF GRAND RIVER |
| Entity Type | Organization |
| Authorized Contact | SIMONE WILSON-ADELEKE Director Of Credentialing 732-914-3991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2024-09-18 |
| Last Update Date | 2024-09-18 |