| NPI | 1467684399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY M PUSKARICH Business Asst. 734-671-8414 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901010486) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901017885) |
| 1223P0300X Dentist, Periodontics (Licence: MI 2901019162) | |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2016-11-02 |