Healthcare Provider Details

I. General information

NPI: 1598575599
Provider Name (Legal Business Name): FACE CANDY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5381 CROOKS RD
TROY MI
48098-2820
US

IV. Provider business mailing address

5381 CROOKS RD
TROY MI
48098-2820
US

V. Phone/Fax

Practice location:
  • Phone: 248-925-2347
  • Fax:
Mailing address:
  • Phone: 248-925-2347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA KHALIL AFR
Title or Position: OWNER
Credential:
Phone: 248-925-2347