| NPI | 1689763872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH W KELLEY Owner President 248-828-3185 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI 2901013476) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-10-02 |