Provider Demographics
NPI:1003414749
Name:GHANDOUR, RAMI (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAMI
Middle Name:
Last Name:GHANDOUR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E LONG LAKE RD APT 8
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2358
Mailing Address - Country:US
Mailing Address - Phone:248-703-0127
Mailing Address - Fax:
Practice Address - Street 1:G3023 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1353
Practice Address - Country:US
Practice Address - Phone:810-720-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600672122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist