Healthcare Provider Details

I. General information

NPI: 1922696939
Provider Name (Legal Business Name): RIVERVIEW PEDIATRIC DENTAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14525 SIBLEY RD STE 2
RIVERVIEW MI
48193-7756
US

IV. Provider business mailing address

45972 WINDRIDGE LN
CANTON MI
48188-6223
US

V. Phone/Fax

Practice location:
  • Phone: 313-404-1061
  • Fax: 734-667-1655
Mailing address:
  • Phone: 313-404-1061
  • Fax: 734-667-1655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: HASSAN OUEIS
Title or Position: OWNER
Credential: DDS
Phone: 313-404-1061