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General NPI Number Information
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NPI Number | 1427568237
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Entity Type | Organization
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Legal Business Name | AMAZING DENTAL PORT HURON PLLC
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 4035 24TH AVE
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3801
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Country | US
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Telephone | 810-385-9766
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Fax |
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Provider Business Mailing Address
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Address Line | 4035 24TH AVE
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3801
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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 | CREDENTIALING
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Name | MS. SHAMS HAMAMA
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Credential |
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Telephone | 248-910-4819
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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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