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General NPI Number Information
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NPI Number | 1649693284
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Entity Type | Organization
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Legal Business Name | FARMINGTON FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 02/03/2014
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 34405 GRAND RIVER
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City | FARMINGTON
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State | MI
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Zip | 48335
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Country | US
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Telephone | 248-478-3285
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Fax | 248-478-9398
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Provider Business Mailing Address
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Address Line | 34405 GRAND RIVER
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City | FARMINGTON
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State | MI
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Zip | 48335
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Country | US
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Telephone | 248-478-3285
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Fax | 248-478-9398
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Authorized Official
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Title or Position | OWNER
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Name | DR. AHMAD DEEBAJAH
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Credential | DDS
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Telephone | 248-478-3285
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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 | 20359
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License Number State | MI
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