Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901021265 | MI |
NPI | 1003218413 |
---|---|
Provider Name | Dr. Suela Veizaj |
First Address | Troy, MI 48083 |
Second Address | Troy, MI 48083-6812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2014 |
Last Update Date | 17/09/2014 |