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30330 W 12 Mile Rd Suite B Farmington Hills MI 48334-3821 | |
| (248) 702-6117 | |
| (248) 702-6118 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 30330 W 12 Mile Rd, Farmington Hills, Michigan |
| Authorized Official Name and Position | Fadi Assaf (OWNER) |
| Authorized Official Contact | 2487026117 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
30330 W 12 Mile Rd Suite B Farmington Hills MI 48334-3821 Ph: (248) 702-6117 | 30330 W 12 Mile Rd Suite B Farmington Hills MI 48334-3821 Ph: (248) 702-6117 |
| NPI Number | 1407395833 |
|---|---|
| Provider Enumeration Date | 02/17/2017 |
| Last Update Date | 02/17/2017 |
| Medicare PECOS PAC ID | 7517402050 |
|---|---|
| Medicare Enrollment ID | O20240709003530 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407395833 | NPI | - | NPPES |
| 2901017447 | Other | MI | LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2901017447 (Michigan) | Primary |
| Provider Name | Fadi Assaf |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1871602854 PECOS PAC ID: 4385934322 Enrollment ID: I20240709003684 |
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