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General NPI Number Information
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NPI Number | 1003414749
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Entity Type | Individual
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Provider Name | RAMI GHANDOUR DMD
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Gender | Male
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Dates
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Enumeration Date | 10/14/2020
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 1259 S WABASH AVE
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City | CHICAGO
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State | IL
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Zip | 60605-2412
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Country | US
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Telephone | 312-846-6752
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Fax |
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Provider Business Mailing Address
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Address Line | 150 E LONG LAKE RD APT 8
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48304-2358
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Country | US
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Telephone | 248-703-0127
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19034050
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License Number State | IL
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