Healthcare Provider Details

I. General information

NPI: 1922972827
Provider Name (Legal Business Name): SHARON SHADI NAMAZI DDS., MS. ENDODONTIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5409 GATEWAY CTR
FLINT MI
48507-3992
US

IV. Provider business mailing address

2801 YOST BLVD
ANN ARBOR MI
48104-5328
US

V. Phone/Fax

Practice location:
  • Phone: 810-235-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901602823
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: