Organization
PROFESSIONAL DENAL ALLIANCE OF MICHIGAN,LLC
Active
Other names
Refresh Dental Southfield - W 10 Mile Rd
Organization subpart
No
Provider details
NPI number
Authorized official
ANNETTE MARLOW (CREDENTIALING SUPERVISOR)
(724) 698-2119
Entity
Organization
Contact information
Practice address
19189 W 10 MILE RD, SOUTHFIELD, MI 48075-2442
(248) 996-8756
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901021424
MI
Other
Enumeration date
03/02/2018
Last updated
03/02/2018
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