Healthcare Provider Details

I. General information

NPI: 1710008065
Provider Name (Legal Business Name): SHYROZE NATHOO REHEMTULLA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 S HURON PKWY
ANN ARBOR MI
48104-5124
US

IV. Provider business mailing address

49828 POWELL RIDGE CT
PLYMOUTH MI
48170-6378
US

V. Phone/Fax

Practice location:
  • Phone: 734-973-9155
  • Fax: 734-973-7084
Mailing address:
  • Phone: 734-667-2123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2901016431
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: