| NPI | 1528139540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ILITCH Vice President 313-838-0490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MI 14256) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2020-08-22 |