Provider Demographics
NPI:1386691244
Name:MUKURAZHIZHA, TARAMBAKUFA DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:TARAMBAKUFA
Middle Name:DAVID
Last Name:MUKURAZHIZHA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2871 TROY CENTER DR
Mailing Address - Street 2:APT P-3
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4727
Mailing Address - Country:US
Mailing Address - Phone:315-440-4525
Mailing Address - Fax:313-494-6842
Practice Address - Street 1:29702 SOUTHFIELD RD
Practice Address - Street 2:SUITE H
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2096
Practice Address - Country:US
Practice Address - Phone:315-440-4525
Practice Address - Fax:248-559-6386
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052732122300000X
MI2901019955122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist