Healthcare Provider Details

I. General information

NPI: 1972060903
Provider Name (Legal Business Name): DR NAZ DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1747 E MICHIGAN AVE
YPSILANTI MI
48198-6069
US

IV. Provider business mailing address

1747 E MICHIGAN AVE
YPSILANTI MI
48198-6069
US

V. Phone/Fax

Practice location:
  • Phone: 734-484-4710
  • Fax:
Mailing address:
  • Phone: 734-484-4710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: NAZLI ASRAR
Title or Position: DENTIST/ OWNER
Credential: DDS
Phone: 734-484-4710