| NPI | 1689081903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMEN M O'MALLEY Member 248-363-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 19031) |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2014-07-18 |