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General NPI Number Information
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NPI Number | 1710945308
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Entity Type | Individual
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Provider Name | ABRAHAM LAWRENCE AZZOUZ D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 24366 GRAND RIVER AVE SUITE 111
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City | DETROIT
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State | MI
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Zip | 48219-3063
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Country | US
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Telephone | 313-535-2273
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Fax | 313-535-5212
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Provider Business Mailing Address
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Address Line | 24366 GRAND RIVER AVE SUITE 111
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City | DETROIT
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State | MI
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Zip | 48219-3063
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Country | US
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Telephone | 313-535-2273
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Fax | 313-535-5212
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901015675
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902014138
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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