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Dental Providers Dentist

Provider NPI: 1558671370

Organization Information:
Organization is not Subpart
Authorized Official:  SANDRA T VANDEVELDE  OWNER/MANAGER  248-977-1012

Practice Location:
Tel: 248-977-1012  Fax: --

Business Mailing Address:
Tel: 248-977-1012  Fax: --

NPI Information:
NPI: 1558671370
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Y122300000XDental Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 122300000X





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