Provider Demographics
NPI:1710076211
Name:HAJJI, RUDY N (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUDY
Middle Name:N
Last Name:HAJJI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17272 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3151
Mailing Address - Country:US
Mailing Address - Phone:734-266-2050
Mailing Address - Fax:734-266-7170
Practice Address - Street 1:17272 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3151
Practice Address - Country:US
Practice Address - Phone:734-266-2050
Practice Address - Fax:734-266-7170
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0174401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01374821OtherUNITED CONCORDIA
MI4344000Medicaid