Organization
COMMUNITY DENTISTRY PLUS,P,C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHAYRI KASSAB (OWNER DENTIST)
(248) 790-3738
Entity
Organization
Contact information
Practice address
18161 W 12 MILE RD, SUIT 2, LATHRUP VILLAGE, MI 48076-2662
(248) 790-3738
(248) 552-3777
Mailing address
30480 SHOREHAM ST, SOUTHFIELD, MI 48076-5368
(248) 790-3738
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
29010109220
MI
Other
Enumeration date
03/18/2007
Last updated
11/06/2007
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