| NPI | 1801970124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY RATOWSKI Director 248-703-2003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 830190) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2024-03-06 |