Healthcare Provider Details

I. General information

NPI: 1225816788
Provider Name (Legal Business Name): HAFSA AFFENDI BDS, MDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HAFSA EFFENDI BDS

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLUE WATER ENDODONTICS HOLLAND DENTAL CENTRE 1982 HOLLAND AVENUE
PORT HURON MI
48060
US

IV. Provider business mailing address

1982 HOLLAND AVE
PORT HURON MI
48060-1520
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-7300
  • Fax:
Mailing address:
  • Phone: 810-985-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901601247
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: