| NPI | 1962472373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES SMITH Dentist/Owner 586-296-1943 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI 2901015672) |
| Additional Taxonomies | 122300000X Dentist |
| 1223E0200X Dentist Endodontics | |
| 1223P0221X Dentist Pediatric Dentistry | |
| 1223P0300X Dentist Periodontics | |
| 1223P0700X Dentist Prosthodontics | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2016-12-09 |