Healthcare Provider Details

I. General information

NPI: 1992762454
Provider Name (Legal Business Name): CONTEMPORARY DENTISTRY & IMPLANTOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 N SHELDON RD
CANTON MI
48187-3150
US

IV. Provider business mailing address

5645 N SHELDON RD
CANTON MI
48187-3150
US

V. Phone/Fax

Practice location:
  • Phone: 734-455-0095
  • Fax: 734-455-0099
Mailing address:
  • Phone: 734-455-0095
  • Fax: 734-455-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2901017182
License Number StateMI

VIII. Authorized Official

Name: MR. NADER BAZZI
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 734-455-0095