NPIMap

Organization Active NPI

Grand River Family Dentistry P.C.

  • General Practice Dentistry
  • Detroit, MI
National Provider Identifier
1467401141
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901015675 Issued in MI
Legal business name
GRAND RIVER FAMILY DENTISTRY P.C.
Practice address
24366 Grand River Ave
Suite 111
Detroit, MI 48219-3063
Phone
(313) 535-2273
Fax
(313) 535-5212
NPI assigned
May 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Abraham Lawrence Azzouz, D.D.S.NPI 1710945308
Title
President Dentist
Phone
(313) 535-2273

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 2901015675 MI Primary

Addresses

Primary practice location

24366 Grand River Ave
Suite 111
Detroit, MI 48219-3063

Mailing address

24366 Grand River Ave
Suite 111
Detroit, MI 48219-3063
Phone (313) 535-2273

Other identifiers 4

IdentifierTypeStateIssuer
BA2373443OtherU.S. D.E.A.
873745OtherMIUNITED CONCORDIA
D800185OtherMIBLUE CROSS BLUE SHEILD
3197750MedicaidMI

National Provider Directory

National Provider Directory

Locations

24366 Grand River Ave
Ste 111
Detroit, MI 48219
Phone (313) 535-2273

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467401141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24366 GRAND RIVER AVE",
            "address_2": "SUITE 111",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482193063",
            "telephone_number": "313-535-2273",
            "fax_number": "313-535-5212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24366 GRAND RIVER AVE",
            "address_2": "SUITE 111",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482193063",
            "telephone_number": "313-535-2273",
            "fax_number": "313-535-5212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND RIVER FAMILY DENTISTRY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AZZOUZ",
        "authorized_official_first_name": "ABRAHAM",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "PRESIDENT DENTIST",
        "authorized_official_telephone_number": "313-535-2273",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901015675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U.S. D.E.A.",
            "identifier": "BA2373443",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "873745",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "D800185",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3197750",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.