MEDICARE: RANA AZZO, 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	261QD0000X	Dental Clinic/Center	2901020537	MI

General Provider Information

NPI Number	:	1942668223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANA AZZO, DDS, PLLC

Provider Business Mailing Address
First Line	:	2141 15 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4807
Country	:	US
Telephone Number	:	586-330-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2141 15 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4807
Country	:	US
Telephone Number	:	586-330-1800
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MRS. RANA ADNAN-HANNA AZZO
Credential	:	DDS
Telephone Number	:	248-974-7405

Provider Enumeration Date	:	02/02/2016
Last Update Date	:	02/02/2016

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