Provider Demographics
NPI:1326343542
Name:MEDAPLEX P.C.
Entity Type:Organization
Organization Name:MEDAPLEX P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WAFID
Authorized Official - Middle Name:W
Authorized Official - Last Name:KIZY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:248-968-2748
Mailing Address - Street 1:23350 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2496
Mailing Address - Country:US
Mailing Address - Phone:248-968-2748
Mailing Address - Fax:248-968-2742
Practice Address - Street 1:23350 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2496
Practice Address - Country:US
Practice Address - Phone:248-968-2748
Practice Address - Fax:248-968-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1823026261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental