| NPI | 1477792620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL COSTELLO Manager 248-543-7070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 014041) |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2009-02-11 |