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Organization

DEVELOPMENTAL DENTISTRY, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. SUE FAGAN (BUSINESS COORDINATOR)
(313) 576-2538
Entity
Organization

Contact information

Practice address
79 W ALEXANDRINE ST, 3RD. FLOOR, DETROIT, MI 48201-2015
(313) 576-2538
(313) 576-2534
Mailing address
79 W ALEXANDRINE ST, 3RD. FLOOR, DETROIT, MI 48201-2015
(313) 576-2538
(313) 576-2534

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
124Q00000X
Dental Hygienist

Other

Enumeration date
09/08/2008
Last updated
09/08/2008
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