# WOLVERINE COSMETIC DENTAL L.L.C

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881859239
- **Authorized official:** SAHAR BARBAT D.D.S (DOCTOR)
- **Authorized official phone:** (248) 395-4700

## Contact information

- **Practice address:** 17070 W. 12 MILE RD, C, SOUTHFIELD, MI 48076-2116
- **Practice address phone:** (248) 395-4700
- **Practice address fax:** (248) 395-4703
- **Mailing address:** 17070 W 12 MILE RD, C, SOUTHFIELD, MI 48076-2116
- **Mailing address phone:** (248) 395-4700
- **Mailing address fax:** (248) 395-4703

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2901019508 | MI | Yes |

## Other

- **Enumeration date:** 07/25/2008
- **Last updated:** 07/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1437252467 | — | MI |
| 05 | — | 1497949945 | — | MI |