Provider Demographics
NPI:1093400640
Name:MZAJ DENTAL
Entity Type:Organization
Organization Name:MZAJ DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ISKANDAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-717-5752
Mailing Address - Street 1:6061 W VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-2085
Mailing Address - Country:US
Mailing Address - Phone:313-841-1010
Mailing Address - Fax:
Practice Address - Street 1:6061 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2085
Practice Address - Country:US
Practice Address - Phone:313-841-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental