| NPI | 1922086370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIEGO VELASQUEZ-PLATA President 810-750-3400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI 18270) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2020-08-22 |