Provider Demographics
NPI:1912320912
Name:MAYFAIR DENTAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:MAYFAIR DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-363-3304
Mailing Address - Street 1:30335 W 13 MILE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2262
Mailing Address - Country:US
Mailing Address - Phone:248-487-4013
Mailing Address - Fax:248-747-4185
Practice Address - Street 1:30335 W 13 MILE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2262
Practice Address - Country:US
Practice Address - Phone:248-487-4013
Practice Address - Fax:248-747-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI160851223G0001X
MI99181223G0001X
MI191621223P0300X
MI83931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty