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NPI Code Detail

MEDICARE: ELITE DENTAL GROUPS

MEDICARE: ELITE DENTAL GROUPS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2901020171MI

General Provider Information

NPI Number : 1003183757
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELITE DENTAL GROUPS
Provider Business Mailing Address
First Line : 1658 MIDDLEBELT RD
Second Line :
City : GARDEN CITY
State : MI
Zip : 48135-2879
Country : US
Telephone Number : 734-421-1181
Fax Number :
Provider Business Practice Location Address
First Line : 1658 MIDDLEBELT RD
Second Line :
City : GARDEN CITY
State : MI
Zip : 48135-2879
Country : US
Telephone Number : 734-421-1181
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. IBRAHIM A AL-MUNIF
Credential : D.D.S., M.S.
Telephone Number : 734-421-1181
Provider Enumeration Date : 11/23/2011
Last Update Date : 11/23/2011

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Directions to “ELITE DENTAL GROUPS ” Practice Location

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