Individual
MS. GINA ADELLE DIAKONOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH, BSDH
Contact information
Practice address
2700 MARTIN LUTHER KING JR BLVD, DETROIT, MI 48208-2576
(313) 494-6962
(313) 494-6709
Mailing address
2700 MARTIN LUTHER KING JR BLVD, DETROIT, MI 48208-2576
(313) 494-6962
(313) 494-6709
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2902015970
MI
Other
Enumeration date
11/18/2015
Last updated
11/18/2015
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