| NPI | 1770896474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK JAMES KELLY Owner 586-790-7360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901009898) |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2010-07-22 |