Provider Demographics
NPI:1619934197
Name:BAZZI, NADER (DDS)
Entity Type:Individual
Prefix:DR
First Name:NADER
Middle Name:
Last Name:BAZZI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 N CANTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2950
Mailing Address - Country:US
Mailing Address - Phone:734-455-0095
Mailing Address - Fax:734-455-0099
Practice Address - Street 1:1325 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2950
Practice Address - Country:US
Practice Address - Phone:734-455-0095
Practice Address - Fax:734-455-0099
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010171821223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice