Organization
SUPREME DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE BLOXSON (PRESIDENT)
(313) 416-6806
Entity
Organization
Contact information
Practice address
27201 RYAN RD, WARREN, MI 48092-5127
(586) 558-8004
Mailing address
27201 RYAN RD, WARREN, MI 48092-5127
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
02/03/2014
Last updated
02/03/2014
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