Gratiot Dental Pc

NPI 1073702478 - Dentist - 122300000X

NPI Details
NPI 1073702478
Enumeration Date 10/22/2007
Last Updated 10/22/2007
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name WALLACE LEE WALLACE
Position PRESIDENT
Phone (313) 527-1140
Fax (313) 527-9022
Practice Location
12645 GRATIOT AVE
DETROIT MI, 48205-3952, US
Phone (313) 527-1140
Fax (313) 527-9022
Business Location
12645 GRATIOT AVE
DETROIT MI, 48205-3952, US
Phone (313) 527-1140
Fax (313) 527-9022
Toxanomy
Taxonomy Code 122300000X
License State Michigan
License Number 12881
Remove 1073702478 NPI Number
 

According to our database, Gratiot Dental Pc NPI is 1073702478, taxonomy code is 122300000X and license number is 12881, license state is located at Michigan. Gratiot Dental Pc physically located at 12645 Gratiot Ave, Detroit MI, 48205-3952. NPI Number 1033115704 has the healthcare provider type.

Sponsored links

1073702478 NPI number is provided on an as is basis without warranty of any kind. 1073702478 is maintained by the National Plan & Provider Enumeration System. The contents of Gratiot Dental Pc are for informational purposes only.