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General NPI Number Information
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NPI Number | 1144847294
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Entity Type | Individual
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Provider Name | REZAN DOKU DDS
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Gender | Male
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Dates
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Enumeration Date | 07/06/2020
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Last Update Date | 07/06/2020
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Provider Practice Location Address
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Address Line | 11552 E 12 MILE RD STE 105
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City | WARREN
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State | MI
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Zip | 48093-2644
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Country | US
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Telephone | 586-573-7500
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Fax | 586-573-7502
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Provider Business Mailing Address
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Address Line | 35249 GRAND PRIX DR
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City | STERLING HEIGHTS
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State | MI
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Zip | 48312-4043
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Country | US
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Telephone | 586-838-7681
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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 | 2901600492
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License Number State | MI
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