MEDICARE: DR. RANA ADNAN AZZO DDS

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	1223G0001X	General Practice Dentistry	2901020537	MI
2	122300000X	Dentist	2901020537	MI

General Provider Information

NPI Number	:	1740561182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANA ADNAN AZZO DDS

Provider Business Mailing Address
First Line	:	4940 W POND CIR
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2278
Country	:	US
Telephone Number	:	248-974-7405
Fax Number	:

Provider Business Practice Location Address
First Line	:	2083 15 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4804
Country	:	US
Telephone Number	:	586-275-2021
Fax Number	:	586-983-9511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2011
Last Update Date	:	06/21/2024

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