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General NPI Number Information
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NPI Number | 1235821620
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Entity Type | Organization
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Legal Business Name | GREAT LAKES PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 05/23/2023
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 701 S MAIN ST
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City | CLAWSON
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State | MI
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Zip | 48017-2017
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Country | US
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Telephone | 248-915-0159
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 BOWERS ST UNIT 229
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City | BIRMINGHAM
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State | MI
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Zip | 48012-7117
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KAREEM RABAA
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Credential | DDS
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Telephone | 248-915-0159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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