| NPI | 1801203583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA DOXTADER CFO 313-576-8657 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2025-02-18 |