Provider Demographics
NPI:1467066613
Name:ALLEN PARK DENTISTRY
Entity Type:Organization
Organization Name:ALLEN PARK DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-461-5282
Mailing Address - Street 1:11250 E 13 MILE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2597
Mailing Address - Country:US
Mailing Address - Phone:586-574-9500
Mailing Address - Fax:
Practice Address - Street 1:8400 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1430
Practice Address - Country:US
Practice Address - Phone:313-928-8848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty