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General NPI Number Information
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NPI Number | 1083729370
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Entity Type | Organization
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Legal Business Name | RANDA JUNDI-SAMMAN DMD & ALISTER M MACKENZIE DDS PC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1105 SEDGWICK ST
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City | PORT HURON
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State | MI
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Zip | 48060
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Country | US
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Telephone | 810-984-2742
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Fax | 810-984-8934
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Provider Business Mailing Address
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Address Line | 1105 SEDGWICK ST
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City | PORT HURON
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State | MI
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Zip | 48060
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Country | US
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Telephone | 810-984-2742
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Fax | 810-984-8934
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Authorized Official
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Title or Position | PRESIDENT DENTIST
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Name | DR. RANDA JUNDI-SAMMAN
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Credential | DMD
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Telephone | 810-984-2742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901008328
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901016445
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License Number State | MI
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