Organization
GRATIOT DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALLACE LEE WALKER DDS (PRESIDENT)
(313) 527-1140
Entity
Organization
Contact information
Practice address
12645 GRATIOT AVE, DETROIT, MI 48205-3952
(313) 527-1140
(313) 527-9022
Mailing address
12645 GRATIOT AVE, DETROIT, MI 48205-3952
(313) 527-1140
(313) 527-9022
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12881
MI
Other
Enumeration date
10/22/2007
Last updated
10/22/2007
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