Provider Demographics
NPI:1194993428
Name:DENTAL REHAB PC
Entity type:Organization
Organization Name:DENTAL REHAB PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:JANDALI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:248-626-6526
Mailing Address - Street 1:26699 W 12 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7815
Mailing Address - Country:US
Mailing Address - Phone:248-626-6526
Mailing Address - Fax:248-626-6529
Practice Address - Street 1:26699 W 12 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7815
Practice Address - Country:US
Practice Address - Phone:248-626-6526
Practice Address - Fax:248-626-6529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010173951223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty