1225816788 NPI number — DR. HAFSA AFFENDI BDS, MDS, MS

Table of content: DR. HAFSA AFFENDI BDS, MDS, MS (NPI 1225816788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225816788 NPI number — DR. HAFSA AFFENDI BDS, MDS, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AFFENDI
Provider First Name:
HAFSA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
BDS, MDS, MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EFFENDI
Provider Other First Name:
HAFSA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225816788
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3077 SIGNATURE BLVD APT B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48103-6495
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
862-298-1877
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 E EISENHOWER PKWY STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48108-3330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-761-3166
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/18/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  23256040901 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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