Organization
KID'S FIRST PEDIATRIC DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAITLIN CORUM (ASSISTANT/FRONT DESK)
(313) 386-0570
Entity
Organization
Contact information
Practice address
3778 DIX HWY, LINCOLN PARK, MI 48146-3807
(313) 386-0570
Mailing address
3778 DIX HWY, LINCOLN PARK, MI 48146-3807
(313) 386-0570
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2901022062
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
VS0034738
—
MI
Enumeration date
01/11/2018
Last updated
09/27/2018
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