| NPI | 1861122871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY DOHERTY Administrative 734-479-2990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2022-06-13 |