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Organization
WEST BLOMMFIELD DENTAL AND ASSOCIATES PLLC
Active
Organization
WEST BLOMMFIELD DENTAL AND ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLEN BRIAN DAVIS (CEO)
(248) 851-5650
Entity
Organization
Contact information
Practice address
6900 ORCHARD LAKE RD, 211, WEST BLOOMFIELD, MI 48322-3405
(248) 851-5650
(248) 851-5663
Mailing address
6900 ORCHARD LAKE RD, 211, WEST BLOOMFIELD, MI 48322-3405
(248) 851-5650
(248) 851-5663
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
017174
MI
124Q00000X
Dental Hygienist
2902011884
MI
124Q00000X
Dental Hygienist
—
NULL
124Q00000X
Dental Hygienist
—
—
Other
Enumeration date
12/06/2010
Last updated
12/06/2010
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