Provider Demographics
NPI:1245753342
Name:RIVERCREST ORTHODONTICS DDS PLLC
Entity Type:Organization
Organization Name:RIVERCREST ORTHODONTICS DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HADI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, FRCD(C)
Authorized Official - Phone:248-652-1244
Mailing Address - Street 1:930 W AVON RD STE 16
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2759
Mailing Address - Country:US
Mailing Address - Phone:248-652-1244
Mailing Address - Fax:
Practice Address - Street 1:930 W AVON RD STE 16
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2759
Practice Address - Country:US
Practice Address - Phone:248-652-1244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010216801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty