Healthcare Provider Details

I. General information

NPI: 1144140104
Provider Name (Legal Business Name): MOHAMMAD ABBAS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 SPRING ARBOR RD
JACKSON MI
49201-7301
US

IV. Provider business mailing address

22222 OAK ST
DEARBORN MI
48128-1454
US

V. Phone/Fax

Practice location:
  • Phone: 517-760-6352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901603252
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: