=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366569105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TIENKEN DENTAL INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 W TIENKEN RD SUITE B
-----------------------------------------------------
City | ROCHESTER HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48306-4474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-656-1505
-----------------------------------------------------
Fax | 248-656-8846
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 W TIENKEN RD SUITE B
-----------------------------------------------------
City | ROCHESTER HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48306-4474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-656-1505
-----------------------------------------------------
Fax | 248-656-8846
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SHERIF EL-SAYD BADR
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 248-656-1505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 013348
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------