Provider Demographics
NPI:1669827812
Name:COMFORT DENTAL SPA LIVONIA PLLC
Entity Type:Organization
Organization Name:COMFORT DENTAL SPA LIVONIA PLLC
Other - Org Name:LIVONIA FAMILY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIR MOHSIN
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:RAZVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-974-2300
Mailing Address - Street 1:16979 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2946
Mailing Address - Country:US
Mailing Address - Phone:248-974-2300
Mailing Address - Fax:248-708-6786
Practice Address - Street 1:16979 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-2946
Practice Address - Country:US
Practice Address - Phone:248-974-2300
Practice Address - Fax:248-708-6786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018778122300000X
MI2901021391122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty