Individual
MANSUR ROY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
12000 E 12 MILE RD, WARREN, MI 48093-3570
(586) 576-4140
Mailing address
12000 E 12 MILE RD, WARREN, MI 48093-3570
(586) 576-4140
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
2901019480
MI
Other
Enumeration date
08/13/2007
Last updated
08/13/2007
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