Provider Demographics
NPI:1447797311
Name:RAZAN ABBASS DDS PC
Entity Type:Organization
Organization Name:RAZAN ABBASS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBASS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-841-5522
Mailing Address - Street 1:9925 DIX STE 101
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1593
Mailing Address - Country:US
Mailing Address - Phone:313-841-5522
Mailing Address - Fax:313-841-8170
Practice Address - Street 1:9925 DIX STE 101
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1593
Practice Address - Country:US
Practice Address - Phone:313-841-5522
Practice Address - Fax:313-841-8170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty