Healthcare Provider Details

I. General information

NPI: 1053684506
Provider Name (Legal Business Name): MELVINDALE FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 OAKWOOD BLVD
MELVINDALE MI
48122-1211
US

IV. Provider business mailing address

3113 OAKWOOD BLVD
MELVINDALE MI
48122-1211
US

V. Phone/Fax

Practice location:
  • Phone: 313-381-3850
  • Fax:
Mailing address:
  • Phone: 313-381-3850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. REDA EL-ZEIN ISMAIL
Title or Position: DENTIST
Credential: DDS
Phone: 313-381-3850