Provider Demographics
NPI:1700418555
Name:DENTAL HOUSE - WATERFORD, PLLC
Entity Type:Organization
Organization Name:DENTAL HOUSE - WATERFORD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTALLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:804-539-6622
Mailing Address - Street 1:4860 WASHTENAW AVE STE D
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-3401
Mailing Address - Country:US
Mailing Address - Phone:804-539-6622
Mailing Address - Fax:
Practice Address - Street 1:5979 HIGHLAND ROAD
Practice Address - Street 2:
Practice Address - City:WATERFORD TWP
Practice Address - State:MI
Practice Address - Zip Code:48327
Practice Address - Country:US
Practice Address - Phone:734-999-9909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty