Healthcare Provider Details

I. General information

NPI: 1033207899
Provider Name (Legal Business Name): SHIRIN SARMAD FAKHRI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2885 E LONG LAKE
TROY MI
48085
US

IV. Provider business mailing address

2885 E LONG LAKE
TROY MI
48085
US

V. Phone/Fax

Practice location:
  • Phone: 248-879-4565
  • Fax: 248-879-4515
Mailing address:
  • Phone: 248-879-4565
  • Fax: 248-879-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901017930
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: