Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901600672 | MI |
NPI | 1003414749 |
---|---|
Provider Name | Dr. Rami Ghandour |
First Address | Bloomfield Hills, MI 48304-2358 |
Second Address | Flint, MI 48507-1353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2020 |
Last Update Date | 17/10/2020 |