Provider Demographics
NPI:1922864396
Name:ALL DENTAL 2 PLLC
Entity Type:Organization
Organization Name:ALL DENTAL 2 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ATHEER
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWZI-JASSIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-495-2493
Mailing Address - Street 1:19233 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19233 15 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-2509
Practice Address - Country:US
Practice Address - Phone:313-212-1418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental