Healthcare Provider Details

I. General information

NPI: 1417753732
Provider Name (Legal Business Name): SLEEP AND CARE CLINIC OF DEARBORN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22190 GARRISON ST STE 204
DEARBORN MI
48124-2235
US

IV. Provider business mailing address

25200 CHERRY HILL ST
DEARBORN MI
48124-1204
US

V. Phone/Fax

Practice location:
  • Phone: 313-900-4158
  • Fax:
Mailing address:
  • Phone: 313-580-6592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. RENNA F HATAHET
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 313-580-6592