MEDICARE: REDA ISMAIL & ASSOCIATES 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	2901019780	MI

General Provider Information

NPI Number	:	1659708360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDA ISMAIL & ASSOCIATES DDS PLLC

Provider Business Mailing Address
First Line	:	24326 W WARREN ST
Second Line	:
City	:	DEARBORN HTS
State	:	MI
Zip	:	48127-2234
Country	:	US
Telephone Number	:	313-381-3850
Fax Number	:	313-389-0046

Provider Business Practice Location Address
First Line	:	24326 W WARREN ST
Second Line	:
City	:	DEARBORN HTS
State	:	MI
Zip	:	48127-2234
Country	:	US
Telephone Number	:	313-381-3850
Fax Number	:	313-389-0046

Authorized Official
Title or Position	:	OWNER
Name	:	MR. REDA EL-ZEIN ISMAIL
Credential	:	DDS
Telephone Number	:	313-381-3850

Provider Enumeration Date	:	09/27/2013
Last Update Date	:	09/27/2013

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