Provider Demographics
NPI:1972975837
Name:MAJESTIC DENTIST PLLC
Entity type:Organization
Organization Name:MAJESTIC DENTIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADUL LATIF
Authorized Official - Middle Name:
Authorized Official - Last Name:HASHWI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-425-1610
Mailing Address - Street 1:32788 FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-6001
Mailing Address - Country:US
Mailing Address - Phone:734-425-1610
Mailing Address - Fax:734-425-1335
Practice Address - Street 1:19254 NEWBURGH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1027
Practice Address - Country:US
Practice Address - Phone:734-425-1610
Practice Address - Fax:734-425-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty