| Fassel P.C. | |
|
25721 Goddard Rd Taylor MI 48180-3974 | |
| (612) 735-9399 | |
| Not Available |
| Full Name | Fassel P.C. |
|---|---|
| Speciality | Dentist |
| Location | 25721 Goddard Rd, Taylor, Michigan |
| Authorized Official Name and Position | Fatima Siddiqui (PRESIDENT) |
| Authorized Official Contact | 6127359399 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fassel P.C. 49767 Parkside Dr Northville MI 48168-6821 Ph: (612) 735-9399 | Fassel P.C. 25721 Goddard Rd Taylor MI 48180-3974 Ph: (612) 735-9399 |
| NPI Number | 1013631902 |
|---|---|
| Provider Enumeration Date | 10/03/2022 |
| Last Update Date | 10/03/2022 |
| Certification Date | 10/03/2022 |
| Medicare PECOS PAC ID | 1254708068 |
|---|---|
| Medicare Enrollment ID | O20221108002935 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013631902 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | () | Primary |
| Provider Name | Fatima Siddiqui |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1366881740 PECOS PAC ID: 2163899972 Enrollment ID: I20221108002970 |
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