Healthcare Provider Details

I. General information

NPI: 1457279762
Provider Name (Legal Business Name): JOE BERJAOUI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 W LAKE LANSING RD STE 200
EAST LANSING MI
48823-8540
US

IV. Provider business mailing address

7444 THEISEN ST
DEARBORN MI
48126-1652
US

V. Phone/Fax

Practice location:
  • Phone: 517-541-4530
  • Fax:
Mailing address:
  • Phone: 313-929-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901603131
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: