| NPI | 1881062941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AZIZ MOUKLED Dentist 519-819-7875 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MI 2901021724) |
| Enumeration Date | 2015-09-07 |
| Last Update Date | 2015-09-07 |