Individual
PREM LATA MISRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
28541 FORD RD, GARDEN CITY, MI 48135-2843
(734) 945-0026
(313) 369-2774
Mailing address
2393 LEXINGTON CIR N, CANTON, MI 48188-5913
(313) 580-8077
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901018026
MI
Other
Enumeration date
10/17/2006
Last updated
05/13/2008
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