Individual
MARISOL ANDREA GEMMA SEGUEL ROA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
13874 GRAND RIVER AVE, DETROIT, MI 48227-3123
(313) 651-7260
Mailing address
285 JOLLY AVE, LASALLE, ONTARIO N9J 3-T1
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901601376
MI
Other
Enumeration date
06/23/2022
Last updated
06/23/2022
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