Organization
DAVID GRACHEK, JR.,DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ODILIA ARIAS (ADMINISTRATIVE)
(734) 284-9873
Entity
Organization
Contact information
Practice address
13745 NORTHLINE RD, SOUTHGATE, MI 48195-1866
(734) 284-9873
(734) 284-4161
Mailing address
13745 NORTHLINE RD, SOUTHGATE, MI 48195-1866
(734) 284-9873
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265591531
—
MI
Enumeration date
01/24/2020
Last updated
01/24/2020
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