Provider Demographics
NPI:1972600070
Name:JOHN J. ABDELMESSIH DDSS PC
Entity Type:Organization
Organization Name:JOHN J. ABDELMESSIH DDSS PC
Other - Org Name:CRESTWOOD DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ABDELMESSIH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-620-5420
Mailing Address - Street 1:6887 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-5107
Mailing Address - Country:US
Mailing Address - Phone:248-620-5420
Mailing Address - Fax:248-620-2036
Practice Address - Street 1:6887 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-5107
Practice Address - Country:US
Practice Address - Phone:248-620-5420
Practice Address - Fax:248-620-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4778171Medicaid