| NPI | 1457523755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KANESHA CANTY Office Manager 248-262-9100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: MI 16026) |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2025-09-05 |