MEDICARE: DR. GUITY M RABBANI DDS MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	013655	MI
2	1223P0300X	Periodontics	30260	CA

General Provider Information

NPI Number	:	1023181427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUITY M RABBANI DDS MS

Provider Business Mailing Address
First Line	:	5008 CHAMPLAIN CIRCLE
Second Line	:
City	:	W BLOOMFIELD
State	:	MI
Zip	:	48323
Country	:	US
Telephone Number	:	586-979-8222
Fax Number	:	586-979-8410

Provider Business Practice Location Address
First Line	:	3637 FIFTEEN MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310
Country	:	US
Telephone Number	:	586-979-8222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/27/2015

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