| NPI | 1811476955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FADY MANSOUR Admin 734-425-6920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI 2901017025) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2018-08-09 |