Individual
DOMINIQUE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18424 KLINGER ST, DETROIT, MI 48234-1718
(313) 618-3342
Mailing address
18424 KLINGER ST, DETROIT, MI 48234-1718
(313) 618-3342
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703111582
MI
Other
Enumeration date
03/10/2015
Last updated
03/10/2015
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