Michigan Dental Team, PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MICHIGAN DENTAL TEAM, PLLC

Practice address

30671 Stephenson Hwy Ste F
Madison Heights, MI 48071-1651

Phone

(717) 759-4375

Fax

(717) 759-4336

NPI assigned

Oct 27, 2023

Last updated

Jan 27, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Diaa Zora

Title

Owner

Phone

(562) 805-5577

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1698364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1578335014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9709 LAKESIDE BLVD STE 350",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773811213",
            "telephone_number": "713-489-2198",
            "fax_number": "713-489-2978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30671 STEPHENSON HWY STE F",
            "city": "MADISON HEIGHTS",
            "state": "MI",
            "postal_code": "480711651",
            "telephone_number": "717-759-4375",
            "fax_number": "717-759-4336"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6240 Rashelle Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Flint",
            "state": "MI",
            "postal_code": "485073938",
            "country_code": "US",
            "telephone_number": "717-759-4375",
            "fax_number": "717-759-4336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MICHIGAN DENTAL TEAM, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-27",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A",
        "authorized_official_last_name": "ZORA",
        "authorized_official_first_name": "DIAA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "562-805-5577"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in Madison Heights, MI
• Providers in Madison Heights, MI by specialty
• Pediatric Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; 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.