Healthcare Provider Details

I. General information

NPI: 1821922154
Provider Name (Legal Business Name): TROY PERIODONTICS & DENTAL IMPLANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 W LONG LAKE RD STE 112
TROY MI
48098-4100
US

IV. Provider business mailing address

2025 W LONG LAKE RD STE 112
TROY MI
48098-4100
US

V. Phone/Fax

Practice location:
  • Phone: 248-267-8900
  • Fax: 248-267-8904
Mailing address:
  • Phone: 248-267-8900
  • Fax: 248-267-8904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. OMAR MARIO MASABNI
Title or Position: PERIODONTIST AND IMPLANT SURGEON
Credential: DDS, MS
Phone: 248-267-8900