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General NPI Number Information
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NPI Number | 1952919631
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Entity Type | Individual
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Provider Name | REEM RIADH ISRAEL DDS
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Gender | Female
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Dates
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Enumeration Date | 07/17/2020
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 2645 COOLIDGE HWY
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City | BERKLEY
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State | MI
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Zip | 48072-1554
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Country | US
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Telephone | 248-541-5510
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Fax |
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Provider Business Mailing Address
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Address Line | 27312 HAMPDEN ST
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-3114
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Country | US
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Telephone | 248-631-9841
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901600551
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License Number State | MI
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