Provider Demographics
NPI:1396816823
Name:RASSAM, BAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BAN
Middle Name:
Last Name:RASSAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 METRO PKWY # 100
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4216
Mailing Address - Country:US
Mailing Address - Phone:586-446-0800
Mailing Address - Fax:586-446-8250
Practice Address - Street 1:2609 METRO PKWY #100
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48310
Practice Address - Country:US
Practice Address - Phone:586-446-0900
Practice Address - Fax:586-446-8250
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017784122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4446860Medicaid