| NPI | 1568043545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEX AWWAD Manager 313-982-7200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2021-05-18 |