Individual
FARAH IMAD HAZIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13874 GRAND RIVER AVE, DETROIT, MI 48227-3123
(313) 651-7260
Mailing address
9789 MAGNOLIA AVE, RIVERSIDE, CA 92503-3642
(951) 352-6300
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
105876
CA
122300000X
Dentist
2901022750
MI
Other
Enumeration date
08/13/2018
Last updated
01/04/2021
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