Healthcare Provider Details

I. General information

NPI: 1114983509
Provider Name (Legal Business Name): KAMRAN A QURESHY D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12124 W LAKESHORE DR
BRIMLEY MI
49715-9319
US

IV. Provider business mailing address

12124 W LAKESHORE DR PO BOX 138
BRIMLEY MI
49715-9319
US

V. Phone/Fax

Practice location:
  • Phone: 906-248-5579
  • Fax: 906-248-5765
Mailing address:
  • Phone: 906-248-5579
  • Fax: 906-248-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901017138
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: