| NPI | 1659936441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WHITNEY WEINER Owner 586-772-0100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics |
| Additional Taxonomies | 1223E0200X Dentist Endodontics |
| 1223G0001X Dentist General Practice | |
| 1223P0106X Dentist Oral and Maxillofacial Pathology | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2019-05-07 |