Organization
WEST BLOMMFIELD DENTAL AND ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLEN BRIAN DAVIS (CEO)
(248) 851-5650
Entity
Organization
Contact information
Practice address
6900 ORCHARD LAKE RD, 211, WEST BLOOMFIELD, MI 48322-3405
(248) 851-5650
(248) 851-5663
Mailing address
6900 ORCHARD LAKE RD, 211, WEST BLOOMFIELD, MI 48322-3405
(248) 851-5650
(248) 851-5663
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
017174
MI
124Q00000X
Dental Hygienist
2902011884
MI
124Q00000X
Dental Hygienist
—
—
Other
Enumeration date
12/06/2010
Last updated
12/06/2010
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