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1325 N Canton Center Rd Canton MI 48187-2950 | |
| (734) 455-0095 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1325 N Canton Center Rd, Canton, Michigan |
| Authorized Official Name and Position | Michael Cole (VP INSURANCE PLAN MANAGEMENT) |
| Authorized Official Contact | 7274242990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1325 N Canton Center Rd Canton MI 48187-2950 Ph: () - | 1325 N Canton Center Rd Canton MI 48187-2950 Ph: (734) 455-0095 |
| NPI Number | 1639895170 |
|---|---|
| Provider Enumeration Date | 10/17/2022 |
| Last Update Date | 07/24/2024 |
| Medicare PECOS PAC ID | 3072053701 |
|---|---|
| Medicare Enrollment ID | O20240910000208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639895170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Nader Bazzi |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1619934197 PECOS PAC ID: 3779562087 Enrollment ID: I20190307000306 |
| Provider Name | Julie Atoui |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1316016140 PECOS PAC ID: 1254588304 Enrollment ID: I20220128000563 |
| Provider Name | Rima A Bazzi |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1356308258 PECOS PAC ID: 6406835719 Enrollment ID: I20220128001315 |
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