Healthcare Provider Details

I. General information

NPI: 1093045627
Provider Name (Legal Business Name): TANYA SAOUR D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35450 DEQUINDRE RD SUITE 101A
STERLING HEIGHTS MI
48310-4810
US

IV. Provider business mailing address

35450 DEQUINDRE RD SUITE 101A
STERLING HEIGHTS MI
48310-4810
US

V. Phone/Fax

Practice location:
  • Phone: 586-264-2515
  • Fax: 586-977-9271
Mailing address:
  • Phone: 586-264-2515
  • Fax: 586-977-9271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901020074
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number27252
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: