Provider Demographics
NPI:1760832158
Name:SHAHROURI, RAMI
Entity Type:Individual
Prefix:DR
First Name:RAMI
Middle Name:
Last Name:SHAHROURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20164 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2710
Mailing Address - Country:US
Mailing Address - Phone:313-205-8320
Mailing Address - Fax:
Practice Address - Street 1:38959 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-3250
Practice Address - Country:US
Practice Address - Phone:313-205-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021876122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist