| NPI | 1639277676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN E GIBNEY Dentist 313-882-7152 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901016252) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2020-08-22 |