Individual
LIDYA JIRJIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2700 MARTIN LUTHER KING JR BLVD, DETROIT, MI 48208-2576
(313) 494-6907
Mailing address
6015 OAK TRL, WEST BLOOMFIELD, MI 48322-2073
(785) 865-8232
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2901022753
MI
122300000X
Dentist
Primary
2951000446
MI
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/12/2018
Last updated
06/28/2022
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