MEDICARE: DR. BAN RASSAM DDS

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	122300000X	Dentist	2901017784	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396816823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BAN RASSAM DDS

Provider Business Mailing Address
First Line	:	2609 METRO PKWY # 100
Second Line	:
City	:	STERLING HTS
State	:	MI
Zip	:	48310-4216
Country	:	US
Telephone Number	:	586-446-0800
Fax Number	:	586-446-8250

Provider Business Practice Location Address
First Line	:	2609 METRO PKWY #100
Second Line	:
City	:	STERLING HTS
State	:	MI
Zip	:	48310
Country	:	US
Telephone Number	:	586-446-0900
Fax Number	:	586-446-8250

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	11/05/2008

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Directions to “ DR. BAN RASSAM DDS” Practice Location

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