| NPI | 1679075782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAPHAEL GOLDSTEIN Owner 248-379-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2018-03-05 |