Provider Demographics
NPI:1396706347
Name:BAIG, MIRZA MURTUZA (DDS)
Entity type:Individual
Prefix:DR
First Name:MIRZA
Middle Name:MURTUZA
Last Name:BAIG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23800 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2560
Mailing Address - Country:US
Mailing Address - Phone:248-755-5700
Mailing Address - Fax:248-471-7383
Practice Address - Street 1:23800 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2560
Practice Address - Country:US
Practice Address - Phone:248-755-5700
Practice Address - Fax:248-471-7383
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010174891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4294490Medicaid