Provider Demographics
NPI:1417028747
Name:TARAKJI, MAJD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAJD
Middle Name:
Last Name:TARAKJI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29150 WESTMONT CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3156
Mailing Address - Country:US
Mailing Address - Phone:248-865-7851
Mailing Address - Fax:
Practice Address - Street 1:24293 TELEGRAPH RD STE 212
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7903
Practice Address - Country:US
Practice Address - Phone:248-223-5639
Practice Address - Fax:248-223-5689
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010174711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID800438OtherBLUE CROSS BLUE SHEILD
MI4413591Medicaid