Organization
ASSOCIATED DENTISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIZAR NAUM MANSOUR DDS MS (PRESIDENT)
(248) 628-3700
Entity
Organization
Contact information
Practice address
129 S WASHINGTON ST, OXFORD, MI 48371
(248) 628-3700
Mailing address
129 S WASHINGTON ST, OXFORD, MI 48371
(248) 628-3700
(248) 628-4374
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
29012608
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12608
BLUE CROSS
—
Enumeration date
11/24/2006
Last updated
08/22/2020
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