Professional Dental Alliance of Romulus, LLC

NPI #1467964700 in Romulus, Michigan

Provider Information

NPI Number: 1467964700
Entity Type: Organization
Organization Name: Professional Dental Alliance of Romulus, LLC
Primary Specialty: Dentist
Enumeration Date: Oct 26, 2017
Last Updated: Oct 26, 2017

Practice Location

Address: 37235 GODDARD RD
City: Romulus
State: Michigan
ZIP Code: 48174-1215
Phone: (734) 941-0343

Authorized Official

Name: ANNETTE MARLOW
Title: CREDENTIALING SUPERVISOR
Phone: (724) 698-2119

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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