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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