Healthcare Provider Details

I. General information

NPI: 1659997716
Provider Name (Legal Business Name): MICHIGAN FAMILY DENTAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26699 W 12 MILE RD STE 110
SOUTHFIELD MI
48034-1578
US

IV. Provider business mailing address

401 COMMERCE DR STE 108
FORT WASHINGTON PA
19034-2724
US

V. Phone/Fax

Practice location:
  • Phone: 248-306-8288
  • Fax: 248-306-8289
Mailing address:
  • Phone: 248-306-8288
  • Fax: 248-306-8289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AHMAD YOSIF
Title or Position: OWNER
Credential: DDS
Phone: 909-967-3444