| NPI | 1851408892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOELLEN MCCORMICK Insurance Supervisor 586-286-0700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2009-09-18 |