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General NPI Number Information
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NPI Number | 1386691244
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Entity Type | Individual
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Provider Name | TARAMBAKUFA DAVID MUKURAZHIZHA DDS
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Gender | Male
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 02/26/2010
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Provider Practice Location Address
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Address Line | 29702 SOUTHFIELD RD SUITE H
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2096
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Country | US
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Telephone | 315-440-4525
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Fax | 248-559-6386
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Provider Business Mailing Address
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Address Line | 2871 TROY CENTER DR APT P-3
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City | TROY
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State | MI
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Zip | 48084-4727
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Country | US
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Telephone | 315-440-4525
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Fax | 313-494-6842
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 052732
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901019955
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License Number State | MI
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