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General NPI Number Information
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NPI Number | 1962795880
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Entity Type | Organization
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Legal Business Name | DENTAL CARE TEAM P C
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 8189 S SAGINAW ST STE A
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City | GRAND BLANC
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State | MI
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Zip | 48439-2494
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Country | US
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Telephone | 810-695-1151
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Fax |
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Provider Business Mailing Address
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Address Line | 8189 S SAGINAW RD STE A
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City | GRAND BLANC
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State | MI
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Zip | 48439-2494
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Country | US
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Telephone | 810-695-1151
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. IBRAHIM JARJOURA
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Credential | D.D.S.
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Telephone | 810-695-1151
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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 | L1622396
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License Number State | MI
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