| Kelly Plaza Dental Ct. Pc | |
|
12434 Kelly Rd. Detroit MI 48224 | |
| (313) 839-8200 | |
| (313) 839-2772 |
| Full Name | Kelly Plaza Dental Ct. Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 12434 Kelly Rd., Detroit, Michigan |
| Authorized Official Name and Position | Wilbert Purifoy (PRESIDENT) |
| Authorized Official Contact | 3138398200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly Plaza Dental Ct. Pc 12434 Kelly Rd Detroit MI 48224-1518 Ph: (313) 839-8200 | Kelly Plaza Dental Ct. Pc 12434 Kelly Rd. Detroit MI 48224 Ph: (313) 839-8200 |
| NPI Number | 1770507451 |
|---|---|
| Provider Enumeration Date | 07/27/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770507451 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 1593854 (Michigan) | Primary |
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