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General NPI Number Information
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NPI Number | 1457877821
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Entity Type | Individual
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Provider Name | BANA MOUREIDEN DMD
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Gender | Female
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 11250 E 13 MILE RD STE 3
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City | WARREN
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State | MI
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Zip | 48093-2597
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Country | US
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Telephone | 586-574-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 2414 ELMDALE RD
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City | UNIVERSITY HEIGHTS
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State | OH
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Zip | 44118-4647
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Country | US
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Telephone | 352-540-5232
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Fax |
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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 | 30.025119
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License Number State | OH
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