Provider Demographics
NPI:1447669015
Name:ELMURADI, SOPHIA (BDS, MS, DDS)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:ELMURADI
Suffix:
Gender:F
Credentials:BDS, MS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23401 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1257
Mailing Address - Country:US
Mailing Address - Phone:267-265-2894
Mailing Address - Fax:
Practice Address - Street 1:23157 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2020
Practice Address - Country:US
Practice Address - Phone:313-561-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X1223S0112X
MI2901023146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery