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Organization
WATERFORD KIDS DENTAL CLUB, PLLC
Active
Organization
WATERFORD KIDS DENTAL CLUB, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REBECA URQUIOLA DDS (OWNER)
(248) 909-2132
Entity
Organization
Contact information
Practice address
3801 ELIZABETH LAKE RD, WATERFORD, MI 48328-3017
(248) 909-2132
Mailing address
4220 SURREY CROSS, BLOOMFIELD HILLS, MI 48301-1669
(248) 909-2132
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/19/2019
Last updated
09/19/2019
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