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General NPI Number Information
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NPI Number | 1821922154
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Entity Type | Organization
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Legal Business Name | TROY PERIODONTICS & DENTAL IMPLANTS
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Dates
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Enumeration Date | 06/11/2026
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Last Update Date | 06/11/2026
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Provider Practice Location Address
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Address Line | 2025 W LONG LAKE RD STE 112
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City | TROY
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State | MI
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Zip | 48098-4100
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Country | US
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Telephone | 248-267-8900
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Fax | 248-267-8904
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Provider Business Mailing Address
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Address Line | 2025 W LONG LAKE RD STE 112
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City | TROY
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State | MI
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Zip | 48098-4100
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Country | US
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Telephone | 248-267-8900
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Fax | 248-267-8904
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Authorized Official
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Title or Position | PERIODONTIST AND IMPLANT SURGEON
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Name | DR. OMAR MARIO MASABNI
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Credential | DDS, MS
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Telephone | 248-267-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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