Provider Demographics
NPI:1861552192
Name:H&S DDS PC
Entity type:Organization
Organization Name:H&S DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HOUSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARAJLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-893-7454
Mailing Address - Street 1:12021 CONANT ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-2716
Mailing Address - Country:US
Mailing Address - Phone:313-893-7454
Mailing Address - Fax:313-893-7504
Practice Address - Street 1:12021 CONANT ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-2716
Practice Address - Country:US
Practice Address - Phone:313-893-7454
Practice Address - Fax:313-893-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017759122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI12-4828756Medicaid