| NPI | 1750532511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE MARIE BLACKFORD Office Manager 734-455-2323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2008-10-09 |