Healthcare Provider Details

I. General information

NPI: 1255264271
Provider Name (Legal Business Name): MOLAR CITY DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22480 KELLY RD STE 1
EASTPOINTE MI
48021-2623
US

IV. Provider business mailing address

22480 KELLY RD STE 1
EASTPOINTE MI
48021-2623
US

V. Phone/Fax

Practice location:
  • Phone: 248-804-0300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALEXANDER KASSHAMOUN
Title or Position: OWNER
Credential: DDS
Phone: 248-804-0300