# WEST GRAND DENTAL, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689813487
- **Authorized official:** MRS. DELORES CAMPBELL (MANAGER)
- **Authorized official phone:** (313) 407-6291

## Contact information

- **Practice address:** 2617 W GRAND BLVD, DETROIT, MI 48208-1234
- **Practice address phone:** (313) 875-3440
- **Practice address fax:** (313) 875-0521
- **Mailing address:** 2617 W GRAND BLVD, DETROIT, MI 48208-1234
- **Mailing address phone:** (313) 875-3440
- **Mailing address fax:** (313) 875-0521

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 15814 | MI | Yes |

## Other

- **Enumeration date:** 02/18/2009
- **Last updated:** 02/18/2009