MEDICARE: DR. HAFSA AFFENDI BDS, MDS, MS

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	1223E0200X	Endodontics	2901601247	MI

General Provider Information

NPI Number	:	1225816788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAFSA AFFENDI BDS, MDS, MS

Provider Business Mailing Address
First Line	:	1982 HOLLAND AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-1520
Country	:	US
Telephone Number	:	810-985-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	BLUE WATER ENDODONTICS
Second Line	:	HOLLAND DENTAL CENTRE 1982 HOLLAND AVENUE
City	:	PORT HURON
State	:	MI
Zip	:	48060
Country	:	US
Telephone Number	:	810-985-7300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	03/20/2026

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