Provider Demographics
NPI:1710008065
Name:REHEMTULLA, SHYROZE NATHOO (DMD)
Entity Type:Individual
Prefix:
First Name:SHYROZE
Middle Name:NATHOO
Last Name:REHEMTULLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49828 POWELL RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6378
Mailing Address - Country:US
Mailing Address - Phone:734-667-2123
Mailing Address - Fax:
Practice Address - Street 1:2345 S HURON PKWY
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5124
Practice Address - Country:US
Practice Address - Phone:734-973-9155
Practice Address - Fax:734-973-7084
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010164311223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics