Provider Demographics
NPI:1760679120
Name:3-D MAXILLOFACIAL IMAGING CENTERS, PLC
Entity Type:Organization
Organization Name:3-D MAXILLOFACIAL IMAGING CENTERS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GHABI
Authorized Official - Middle Name:
Authorized Official - Last Name:KASPO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-740-7770
Mailing Address - Street 1:3144 JOHN R RD
Mailing Address - Street 2:SUITE 100 A
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5930
Mailing Address - Country:US
Mailing Address - Phone:248-740-7770
Mailing Address - Fax:248-714-1447
Practice Address - Street 1:3144 JOHN R RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5930
Practice Address - Country:US
Practice Address - Phone:248-740-7770
Practice Address - Fax:248-519-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty