Organization
PROFESSIONAL DENTAL ALLIANCE OF ROMULUS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNETTE MARLOW (CREDENTIALING SUPERVISOR)
(724) 698-2119
Entity
Organization
Contact information
Practice address
37235 GODDARD RD, ROMULUS, MI 48174-1215
(734) 941-0343
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
(724) 698-2500
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
10/26/2017
Last updated
10/26/2017
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