Provider Demographics
NPI:1073852091
Name:COMMUNITY DENTAL CENTER PLLC
Entity Type:Organization
Organization Name:COMMUNITY DENTAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIGEEB
Authorized Official - Middle Name:
Authorized Official - Last Name:OBEID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-463-3263
Mailing Address - Street 1:4000 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48211-1555
Mailing Address - Country:US
Mailing Address - Phone:313-539-2209
Mailing Address - Fax:
Practice Address - Street 1:4000 MILLER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48211-1555
Practice Address - Country:US
Practice Address - Phone:313-539-2209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID7236A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental