Healthcare Provider Details

I. General information

NPI: 1750597894
Provider Name (Legal Business Name): ADVANCE DENTAL GROUP P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33466 W 8 MILE RD SUITE333
FARMINGTON HILLS MI
48335-5208
US

IV. Provider business mailing address

33466 W 8 MILE RD SUITE333
FARMINGTON HILLS MI
48335-5208
US

V. Phone/Fax

Practice location:
  • Phone: 248-442-2273
  • Fax: 242-442-9499
Mailing address:
  • Phone: 248-442-2273
  • Fax: 242-442-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901015675
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: ABRAHAM L AZZOUZ
Title or Position: DENTIST
Credential: DDS
Phone: 248-442-2273