Organization
KELLY PLAZA DENTAL CT. PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILBERT PURIFOY DDS (PRESIDENT)
(313) 839-8200
Entity
Organization
Contact information
Practice address
12434 KELLY RD., DETROIT, MI 48224
(313) 839-8200
(313) 839-2772
Mailing address
12434 KELLY RD, DETROIT, MI 48224-1518
(313) 839-8200
(313) 839-2772
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1593854
MI
Other
Enumeration date
07/27/2006
Last updated
08/22/2020
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