Provider Demographics
NPI:1861669202
Name:DYNAMIC DENTAL CARE
Entity Type:Organization
Organization Name:DYNAMIC DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZHARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-694-7220
Mailing Address - Street 1:111 SAWYER ST
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1342
Mailing Address - Country:US
Mailing Address - Phone:810-694-7220
Mailing Address - Fax:810-694-7234
Practice Address - Street 1:111 SAWYER ST
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1342
Practice Address - Country:US
Practice Address - Phone:810-694-7220
Practice Address - Fax:810-694-7234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017342261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental