| NPI | 1679721294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE FAGAN Business Coordinator 313-576-2538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| 124Q00000X Dental Hygienist | |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2008-09-08 |