MEDICARE: NEW FARMINGTON GROUP 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	122300000X	Dentist

General Provider Information

NPI Number	:	1659171882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW FARMINGTON GROUP DENTAL PLLC

Provider Business Mailing Address
First Line	:	59041 GRATIOT AVE
Second Line	:
City	:	NEW HAVEN
State	:	MI
Zip	:	48048-2057
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21635 RYAN RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48091-2788
Country	:	US
Telephone Number	:	248-910-4819
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL MANAGER
Name	:	SHAMS HAMAMA
Credential	:
Telephone Number	:	248-910-4819

Provider Enumeration Date	:	03/17/2025
Last Update Date	:	03/25/2025

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