| NPI | 1720551500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SONA FISENKOVA Doctor/Owner 248-987-2879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2019-01-04 |
| Last Update Date | 2022-12-05 |