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General NPI Number Information
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NPI Number | 1578752937
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Entity Type | Organization
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Legal Business Name | REDFORD DENTAL GROUP
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 15148 BEECH DALY RD
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City | REDFORD
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State | MI
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Zip | 48239-3202
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Country | US
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Telephone | 313-533-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 15148 BEECH DALY RD
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City | REDFORD
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State | MI
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Zip | 48239-3202
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Country | US
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Telephone | 313-533-3300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ZEENA J. KAZANGY
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Credential | D.D.S.
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Telephone | 313-535-3300
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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 | 16348
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License Number State | MI
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