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General NPI Number Information
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NPI Number | 1801923172
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Entity Type | Organization
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Legal Business Name | M MAGSOUDI DDS PC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 229 NORTH BAILEY ST
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City | ROMEO
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State | MI
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Zip | 48065
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Country | US
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Telephone | 586-752-2211
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Fax | 586-752-5974
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Provider Business Mailing Address
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Address Line | 229 NORTH BAILEY ST
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City | ROMEO
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State | MI
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Zip | 48065
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Country | US
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Telephone | 586-752-2211
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Fax | 586-752-5974
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MEHROD MAGSOUDI
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Credential | DDS
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Telephone | 586-752-2211
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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 | 15762
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License Number State | MI
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