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Organization
GRAND RIVER FAMILY DENTISTRY P.C.
Active
Organization
GRAND RIVER FAMILY DENTISTRY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ABRAHAM LAWRENCE AZZOUZ D.D.S. (PRESIDENT DENTIST)
(313) 535-2273
Entity
Organization
Contact information
Practice address
24366 GRAND RIVER AVE, SUITE 111, DETROIT, MI 48219-3063
(313) 535-2273
(313) 535-5212
Mailing address
24366 GRAND RIVER AVE, SUITE 111, DETROIT, MI 48219-3063
(313) 535-2273
(313) 535-5212
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901015675
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3197750
—
MI
01
—
873745
UNITED CONCORDIA
MI
01
—
BA2373443
U.S. D.E.A.
—
01
—
D800185
BLUE CROSS BLUE SHEILD
MI
Enumeration date
05/09/2006
Last updated
08/22/2020
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