Organization
FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOHAMMED W IMAM (OWNER)
(313) 581-0710
Entity
Organization
Contact information
Practice address
10326 W WARREN AVE, SUITE 2, DEARBORN, MI 48126-1659
(313) 581-0717
(313) 581-3590
Mailing address
10326 W WARREN AVE, SUITE 2, DEARBORN, MI 48126-1659
(313) 581-0717
(313) 581-3590
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
2901015608
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1649320722
NPI
MI
Enumeration date
04/10/2008
Last updated
04/10/2008
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