Provider Demographics
NPI:1265042378
Name:DENTAL CARE TEAM- FENTON ROAD
Entity type:Organization
Organization Name:DENTAL CARE TEAM- FENTON ROAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JARJOURA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-233-5361
Mailing Address - Street 1:5301 FENTON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48507-4034
Mailing Address - Country:US
Mailing Address - Phone:810-233-5361
Mailing Address - Fax:
Practice Address - Street 1:5301 FENTON RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48507-4034
Practice Address - Country:US
Practice Address - Phone:810-233-5361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty