| NPI | 1962481952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNETTE DUBY Billing Manager 586-791-1490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2017-04-06 |