Provider Demographics
NPI:1295984177
Name:AMIR NAFSO DDS PC
Entity type:Organization
Organization Name:AMIR NAFSO DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-422-3200
Mailing Address - Street 1:36700 WOODWARD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0930
Mailing Address - Country:US
Mailing Address - Phone:248-290-9000
Mailing Address - Fax:
Practice Address - Street 1:36700 WOODWARD AVE STE 200
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0930
Practice Address - Country:US
Practice Address - Phone:248-290-2900
Practice Address - Fax:248-290-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
MI18371122300000X
MI18890122300000X
MI16038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20080125976967Medicaid
MI2008012930092Medicaid
MI20080125078770Medicaid
MI20080125773595Medicaid