Provider Demographics
NPI:1629141619
Name:ABDULRAZZAK, ASMA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASMA
Middle Name:
Last Name:ABDULRAZZAK
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 1:978 CRAIG HILL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9293
Mailing Address - Country:US
Mailing Address - Phone:810-247-0921
Mailing Address - Fax:
Practice Address - Street 1:1509 WASHINGTON ST
Practice Address - Street 2:STE D
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-5612
Practice Address - Country:US
Practice Address - Phone:989-837-9740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID191580OtherBCBS PIN
MI19158OtherDELTA DENTAL
MI2901019158OtherBLUE CROSS BLUE SHIELD ID
MI4795083Medicaid
MIBA9492226OtherDEA