Provider Demographics
NPI:1144641572
Name:SUPREME DENTAL CARE, PLC
Entity type:Organization
Organization Name:SUPREME DENTAL CARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:AOUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-908-1430
Mailing Address - Street 1:25150 FORD RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3115
Mailing Address - Country:US
Mailing Address - Phone:313-908-1430
Mailing Address - Fax:313-406-5068
Practice Address - Street 1:25150 FORD RD
Practice Address - Street 2:SUITE 220
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3115
Practice Address - Country:US
Practice Address - Phone:313-908-1430
Practice Address - Fax:313-406-5068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty