| NPI | 1548447576 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUHEIL MICHAEL BOUTROS CEO/President 810-695-6444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI 16909) |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2022-04-25 |