Healthcare Provider Details

I. General information

NPI: 1639004146
Provider Name (Legal Business Name): SAMANO & KEJBOU DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36700 WOODWARD AVE STE 200
BLOOMFIELD HILLS MI
48304-0930
US

IV. Provider business mailing address

36700 WOODWARD AVE STE 200
BLOOMFIELD HILLS MI
48304-0930
US

V. Phone/Fax

Practice location:
  • Phone: 248-290-2900
  • Fax: 248-290-2904
Mailing address:
  • Phone: 248-290-2900
  • Fax: 248-290-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LACEY SAVAYA
Title or Position: MANAGER/CREDENTIALING
Credential:
Phone: 248-290-2900