Provider Demographics
NPI:1649693284
Name:FARMINGTON FAMILY DENTAL PLLC
Entity type:Organization
Organization Name:FARMINGTON FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:DEEBAJAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-478-3285
Mailing Address - Street 1:34405 GRAND RIVER
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48335
Mailing Address - Country:US
Mailing Address - Phone:248-478-3285
Mailing Address - Fax:248-478-9398
Practice Address - Street 1:34405 GRAND RIVER
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48335
Practice Address - Country:US
Practice Address - Phone:248-478-3285
Practice Address - Fax:248-478-9398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI20359122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty