| NPI | 1831264621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELANIE ELAINE MAYBERRY Dentist Owner 313-835-6758 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MI 2901016544) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2020-08-22 |