Provider Demographics
NPI:1982849683
Name:SOUTHFIELD DENTAL CENTER PC
Entity Type:Organization
Organization Name:SOUTHFIELD DENTAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:SAAD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MURAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-552-8200
Mailing Address - Street 1:17727 W. TEN MILE RD.
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-552-8200
Mailing Address - Fax:248-552-9955
Practice Address - Street 1:17727 W. TEN MILE RD.
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-552-8200
Practice Address - Fax:248-552-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI 0163711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty