| NPI | 1477621290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROY D MCANNALLY Orthodontist 248-647-0696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901011253 0935920) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MI 2901011253 0936712) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2020-08-22 |