Provider Demographics
NPI:1083729370
Name:RANDA JUNDI-SAMMAN DMD & ALISTER M MACKENZIE DDS PC
Entity Type:Organization
Organization Name:RANDA JUNDI-SAMMAN DMD & ALISTER M MACKENZIE DDS PC
Other - Org Name:HURON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNDI-SAMMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:810-984-2742
Mailing Address - Street 1:1105 SEDGWICK ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060
Mailing Address - Country:US
Mailing Address - Phone:810-984-2742
Mailing Address - Fax:810-984-8934
Practice Address - Street 1:1105 SEDGWICK ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060
Practice Address - Country:US
Practice Address - Phone:810-984-2742
Practice Address - Fax:810-984-8934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016445122300000X
MI2901008328122300000X
MI261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty