# KELLY PLAZA DENTAL CT. PC

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

## Provider details

- **NPI number:** 1770507451
- **Authorized official:** DR. WILBERT PURIFOY DDS (PRESIDENT)
- **Authorized official phone:** (313) 839-8200

## Contact information

- **Practice address:** 12434 KELLY RD., DETROIT, MI 48224
- **Practice address phone:** (313) 839-8200
- **Practice address fax:** (313) 839-2772
- **Mailing address:** 12434 KELLY RD, DETROIT, MI 48224-1518
- **Mailing address phone:** (313) 839-8200
- **Mailing address fax:** (313) 839-2772

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1593854 | MI | Yes |

## Other

- **Enumeration date:** 07/27/2006
- **Last updated:** 08/22/2020