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General NPI Number Information
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NPI Number | 1922696939
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Entity Type | Organization
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Legal Business Name | RIVERVIEW PEDIATRIC DENTAL CARE PC
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Dates
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Enumeration Date | 01/05/2021
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 14525 SIBLEY RD STE 2
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City | RIVERVIEW
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State | MI
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Zip | 48193-7756
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Country | US
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Telephone | 313-404-1061
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Fax | 734-667-1655
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Provider Business Mailing Address
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Address Line | 45972 WINDRIDGE LN
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City | CANTON
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State | MI
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Zip | 48188-6223
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Country | US
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Telephone | 313-404-1061
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Fax | 734-667-1655
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Authorized Official
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Title or Position | OWNER
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Name | HASSAN OUEIS
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Credential | DDS
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Telephone | 313-404-1061
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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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