Organization · NPI-2

Ford Dental Group

Preferred Provider Organization · Dearborn, MI

NPI number1881062941
StatusActive
Last updated in NPPESSep 7, 2015

Details

NPI
1881062941
Entity type
Organization (NPI-2)
Legal business name
Ford Dental Group
Organization subpart
No
Enumeration date
Sep 7, 2015
Last updated
Sep 7, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
305R00000X Preferred Provider Organization2901021724MIYes

Practice location

5601 Schaefer Rd Ste 101
Dearborn, MI 48126-4713

Phone 313-582-4800

Mailing address

5601 Schaefer Rd Ste 101
Dearborn, MI 48126-4713

Phone 313-582-4800

Authorized official

Aziz Moukled
Dentist
5198197875

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