Organization
LIVERNOIS DENTAL CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA ANN CHISELOM (OFFICE MANAGER)
(313) 977-0255
Entity
Organization
Contact information
Practice address
17170 LIVERNOIS AVE, DETROIT, MI 48221-3028
(313) 340-9709
(313) 397-9245
Mailing address
17170 LIVERNOIS AVE, DETROIT, MI 48221-3028
(313) 340-9709
(313) 397-9245
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/10/2019
Last updated
05/10/2019
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