Provider Demographics
NPI:1679792253
Name:PERVEZ, GULAFSHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GULAFSHAN
Middle Name:
Last Name:PERVEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GULAFSHAN
Other - Middle Name:A
Other - Last Name:MUNSHEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3020 PACKARD RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2000
Mailing Address - Country:US
Mailing Address - Phone:734-528-9132
Mailing Address - Fax:734-528-9131
Practice Address - Street 1:3020 PACKARD RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2000
Practice Address - Country:US
Practice Address - Phone:734-528-9132
Practice Address - Fax:734-528-9131
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010171991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1695213OtherUNITED CONCORDIA
MI4419601Medicaid