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General NPI Number Information
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NPI Number | 1760679120
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Entity Type | Organization
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Legal Business Name | 3-D MAXILLOFACIAL IMAGING CENTERS, PLC
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 3144 JOHN R RD SUITE 100
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City | TROY
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State | MI
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Zip | 48083-5930
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Country | US
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Telephone | 248-740-7770
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Fax | 248-519-0300
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Provider Business Mailing Address
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Address Line | 3144 JOHN R RD SUITE 100 A
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City | TROY
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State | MI
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Zip | 48083-5930
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Country | US
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Telephone | 248-740-7770
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Fax | 248-714-1447
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Authorized Official
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Title or Position | OWNER
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Name | DR. GHABI KASPO
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Credential | DDS
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Telephone | 248-740-7770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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