Provider Demographics
NPI:1245903400
Name:CHARAFEDDINE, HAMZEH (DDS)
Entity type:Individual
Prefix:MR
First Name:HAMZEH
Middle Name:
Last Name:CHARAFEDDINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 ADAMS RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-9148
Mailing Address - Country:US
Mailing Address - Phone:313-977-0269
Mailing Address - Fax:
Practice Address - Street 1:1124 28TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-2855
Practice Address - Country:US
Practice Address - Phone:616-530-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI2901601113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program