1649976077 NPI number — FADI ASSAF DDS VI PLLC

Table of content: (NPI 1649976077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649976077 NPI number — FADI ASSAF DDS VI PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FADI ASSAF DDS VI PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649976077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30330 W 12 MILE RD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48334-3821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-702-6117
Provider Business Mailing Address Fax Number:
248-702-6118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4101 JOHN R ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-680-0775
Provider Business Practice Location Address Fax Number:
248-680-1108
Provider Enumeration Date:
02/07/2023

Additional Information

Authorized Official

Authorized Official Last Name:
GJOKAJ
Authorized Official First Name:
SOFI
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
248-702-6117

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com