| NPI | 1790145381 |
|---|---|
| Former Legal Business Name | FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | CHERYL LYNN DELISE Business Manager 734-522-6340 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 1447409800) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 1972551810) |
| Enumeration Date | 2016-02-25 |
| Last Update Date | 2016-02-25 |