Provider Demographics
NPI:1083861470
Name:ZEENA J KAZANGY, D.D.S.
Entity type:Organization
Organization Name:ZEENA J KAZANGY, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:CORRINE
Authorized Official - Last Name:CERVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-227-5008
Mailing Address - Street 1:6061 W. VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-2085
Mailing Address - Country:US
Mailing Address - Phone:313-841-1010
Mailing Address - Fax:313-841-4709
Practice Address - Street 1:6061 W. VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2085
Practice Address - Country:US
Practice Address - Phone:313-841-1010
Practice Address - Fax:313-841-4709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3186292Medicaid