| NPI | 1497939607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORIA LARKINS Vice President Finance 313-578-2164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: MI 261QS0112X) |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2008-03-24 |