Provider Demographics
NPI:1669194213
Name:ALL DENTAL PLLC
Entity type:Organization
Organization Name:ALL DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ATHEER
Authorized Official - Middle Name:
Authorized Official - Last Name:JASSIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-804-7171
Mailing Address - Street 1:26401 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1905
Mailing Address - Country:US
Mailing Address - Phone:586-804-7171
Mailing Address - Fax:586-723-7848
Practice Address - Street 1:26401 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1905
Practice Address - Country:US
Practice Address - Phone:586-804-7171
Practice Address - Fax:586-723-7848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental