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12021 Conant St Hamtramck MI 48212-2716 | |
| (313) 893-7454 | |
| (313) 893-7504 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 12021 Conant St, Hamtramck, Michigan |
| Authorized Official Name and Position | Houssein Harajli (DENTIST) |
| Authorized Official Contact | 3138937454 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12021 Conant St Hamtramck MI 48212-2716 Ph: (313) 893-7454 | 12021 Conant St Hamtramck MI 48212-2716 Ph: (313) 893-7454 |
| NPI Number | 1861552192 |
|---|---|
| Provider Enumeration Date | 12/08/2006 |
| Last Update Date | 06/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861552192 | NPI | - | NPPES |
| 12-4828756 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2901017759 (Michigan) | Primary |
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