| NPI | 1871233775 |
|---|---|
| Doing Business As | GREAT LAKES FAMILY DENTAL, LIVONIA |
| Entity Type | Organization |
| Authorized Contact | MICHAEL ANGELO SCIALABBA Chief Clinical Officer 561-512-2709 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2022-03-30 |