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General NPI Number Information
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NPI Number | 1578335014
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Entity Type | Organization
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Legal Business Name | MICHIGAN DENTAL TEAM, PLLC
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Dates
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Enumeration Date | 10/27/2023
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 30671 STEPHENSON HWY STE F
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-1651
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Country | US
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Telephone | 717-759-4375
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Fax | 717-759-4336
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Provider Business Mailing Address
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Address Line | 9709 LAKESIDE BLVD STE 350
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City | SPRING
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State | TX
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Zip | 77381-1213
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Country | US
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Telephone | 713-489-2198
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Fax | 713-489-2978
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Authorized Official
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Title or Position | OWNER
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Name | DIAA ZORA
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Credential |
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Telephone | 562-805-5577
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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