| NPI | 1487829743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETTY J BANKS Office Manager 248-865-0065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 17467) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2008-07-29 |