Healthcare Provider Details

I. General information

NPI: 1396561064
Provider Name (Legal Business Name): SAEED ABDELAZIZ ELREFAEI PHD, MSCS AND B.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N UNIVERSITY AVE
ANN ARBOR MI
48109-1078
US

IV. Provider business mailing address

1011 N UNIVERSITY AVE OFC 2004
ANN ARBOR MI
48109-1078
US

V. Phone/Fax

Practice location:
  • Phone: 734-763-6933
  • Fax:
Mailing address:
  • Phone: 414-554-3110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2952000869
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: