| NPI | 1629244272 |
|---|---|
| Doing Business As | BROAD STREET DENTAL |
| Entity Type | Organization |
| Authorized Contact | MAIRA M RODRIGUEZ President 734-426-8292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901018189) |
| Enumeration Date | 2008-05-04 |
| Last Update Date | 2008-05-04 |