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General NPI Number Information
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NPI Number | 1124897772
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Entity Type | Organization
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Legal Business Name | NORTHEND MANAGEMENT GROUP LLC
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Dates
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Enumeration Date | 12/22/2023
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 7591 E 9 MILE RD
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City | WARREN
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State | MI
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Zip | 48091-2644
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Country | US
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Telephone | 586-578-9898
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Fax | 586-578-9851
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Provider Business Mailing Address
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Address Line | 7591 E 9 MILE RD
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City | WARREN
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State | MI
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Zip | 48091-2644
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Country | US
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Telephone | 586-578-9898
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Fax | 586-578-9851
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Authorized Official
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Title or Position | OWNER
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Name | RANA KIZY
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Credential | MANAGER
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Telephone | 248-535-5024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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