Organization
EASTSIDE FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FADI GEORGE KEYORKGY D.D.S., M.S.D. (OWNER)
(586) 566-5660
Entity
Organization
Contact information
Practice address
48926 SCHOENHERR RD., SHELBY TOWNSHIP, MI 48315
(586) 566-5660
Mailing address
48926 SCHOENHERR RD., SHELBY TOWNSHIP, MI 48315
(586) 566-5660
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901016598
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3369505
—
MI
Enumeration date
04/07/2010
Last updated
04/07/2010
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