| NPI | 1932319746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINALD BERNARD JEWELL President 313-535-7770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 17336) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-10-01 |