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General NPI Number Information
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NPI Number | 1285490441
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Entity Type | Organization
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Legal Business Name | ALL STAR KIDS PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 4925 S TELEGRAPH RD
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48125-2027
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Country | US
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Telephone | 313-254-0777
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Fax |
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Provider Business Mailing Address
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Address Line | 1849 N DENWOOD ST
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City | DEARBORN
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State | MI
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Zip | 48128-1156
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMMED SOBH
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Credential | DDS
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Telephone | 313-663-6484
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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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