Healthcare Provider Details

I. General information

NPI: 1649976077
Provider Name (Legal Business Name): FADI ASSAF DDS VI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 JOHN R ROAD SUITE 100
TROY MI
48085
US

IV. Provider business mailing address

30330 W 12 MILE RD STE B
FARMINGTON HILLS MI
48334-3821
US

V. Phone/Fax

Practice location:
  • Phone: 248-680-0775
  • Fax: 248-680-1108
Mailing address:
  • Phone: 248-702-6117
  • Fax: 248-702-6118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SOFI GJOKAJ
Title or Position: OFFICE MANAGER
Credential:
Phone: 248-702-6117