MEDICARE: ZPEARLYWHITESPLC

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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1124722053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZPEARLYWHITESPLC

Provider Business Mailing Address
First Line	:	24415 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24415 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2223
Country	:	US
Telephone Number	:	313-278-4470
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ZEINAB SOBH ABBAS
Credential	:	DDS
Telephone Number	:	313-600-0248

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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