MEDICARE: LAPEER FAMILY DENTAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1457131682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAPEER FAMILY DENTAL PLLC

Provider Business Mailing Address
First Line	:	2720 BURNINGBUSH DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-4526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 BURNINGBUSH DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-4526
Country	:	US
Telephone Number	:	586-709-4210
Fax Number	:

Authorized Official
Title or Position	:	DDS
Name	:	MAZIN KIZY
Credential	:	DDS
Telephone Number	:	586-709-4210

Provider Enumeration Date	:	10/04/2023
Last Update Date	:	10/04/2023

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