| NPI | 1710500921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA THOMAS Manager 248-321-1625 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2020-05-21 |