Healthcare Provider Details

I. General information

NPI: 1457843476
Provider Name (Legal Business Name): RANI HADLA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 08/31/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16160 MIDDLEBELT RD
LIVONIA MI
48154-3338
US

IV. Provider business mailing address

3909 WOODWARD AVE APT 212
DETROIT MI
48201-2087
US

V. Phone/Fax

Practice location:
  • Phone: 734-396-8381
  • Fax:
Mailing address:
  • Phone: 925-428-7795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901601139
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: