MEDICARE: CHANNO DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1447001912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANNO DDS PLLC

Provider Business Mailing Address
First Line	:	1100 W UNIVERSITY DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-1878
Country	:	US
Telephone Number	:	248-651-3317
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 W UNIVERSITY DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-1878
Country	:	US
Telephone Number	:	248-651-3317
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SARMAD CHANNO
Credential	:
Telephone Number	:	248-651-3317

Provider Enumeration Date	:	04/01/2024
Last Update Date	:	04/01/2024

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