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NPI Code Detail

MEDICARE: KOUROSH B AMIRI D.D.S.

MEDICARE: KOUROSH B AMIRI D.D.S.
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
11223G0001XGeneral Practice Dentistry2901018678MI

General Provider Information

NPI Number : 1770555419
Entity Type Code : Individual
Provider Name (Legal Business Name) : KOUROSH B AMIRI D.D.S.
Provider Business Mailing Address
First Line : 574 LEGACY CT NE
Second Line :
City : ROCKFORD
State : MI
Zip : 49341-7333
Country : US
Telephone Number : 616-799-2838
Fax Number :
Provider Business Practice Location Address
First Line : 2426 BURTON ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-4898
Country : US
Telephone Number : 616-799-2838
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2006
Last Update Date : 01/28/2009

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Directions to “ KOUROSH B AMIRI D.D.S.” Practice Location

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