Provider Demographics
NPI:1407439540
Name:MID MICHIGAN DENTAL CENTER P C
Entity Type:Organization
Organization Name:MID MICHIGAN DENTAL CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AYAZ
Authorized Official - Middle Name:P
Authorized Official - Last Name:JAFRI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:989-729-1999
Mailing Address - Street 1:1425 N M 52
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1234
Mailing Address - Country:US
Mailing Address - Phone:989-729-1999
Mailing Address - Fax:989-729-9949
Practice Address - Street 1:1425 N M 52
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1234
Practice Address - Country:US
Practice Address - Phone:989-729-1999
Practice Address - Fax:989-729-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty