Provider Demographics
NPI:1821007923
Name:JANDALI, RAMI (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:RAMI
Middle Name:
Last Name:JANDALI
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26699 W 12 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7815
Mailing Address - Country:US
Mailing Address - Phone:248-626-6526
Mailing Address - Fax:248-626-6529
Practice Address - Street 1:26699 W 12 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7815
Practice Address - Country:US
Practice Address - Phone:248-626-6526
Practice Address - Fax:248-626-6529
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010173951223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIV03405Medicare UPIN