| NPI | 1801313358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAYNA CORDEN Owner 248-910-2194 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 021002770) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: IL 019030838) |
| 261QD0000X Clinic/Center, Dental (Licence: IL 319020139) | |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2024-05-03 |