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General NPI Number Information
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NPI Number | 1548612872
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Entity Type | Organization
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Legal Business Name | MY FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 07/11/2016
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Last Update Date | 07/11/2016
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Provider Practice Location Address
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Address Line | 626 N CROOKS RD
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City | CLAWSON
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State | MI
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Zip | 48017-1310
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Country | US
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Telephone | 586-939-7788
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Fax | 586-303-0053
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Provider Business Mailing Address
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Address Line | 18800 W 10 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2654
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Country | US
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Telephone | 586-939-7788
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Fax | 586-303-0053
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Authorized Official
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Title or Position | MANAGER
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Name | NABIH KIZY
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Credential |
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Telephone | 586-939-7788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901018613
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License Number State | MI
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