Provider Demographics
NPI:1447934666
Name:OPTIMAL DENTAL GROUP PLLC
Entity type:Organization
Organization Name:OPTIMAL DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-315-9723
Mailing Address - Street 1:30260 CHERRY HILL RD STE B
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2676
Mailing Address - Country:US
Mailing Address - Phone:313-915-3771
Mailing Address - Fax:
Practice Address - Street 1:30260 CHERRY HILL RD STE B
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2676
Practice Address - Country:US
Practice Address - Phone:313-915-3771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental