Provider Demographics
NPI:1669624177
Name:RASSAM, ANGELA M (DDS)
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:M
Last Name:RASSAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4111
Mailing Address - Country:US
Mailing Address - Phone:248-363-7121
Mailing Address - Fax:248-363-7263
Practice Address - Street 1:9600 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-4111
Practice Address - Country:US
Practice Address - Phone:248-363-7121
Practice Address - Fax:248-363-7263
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI19883122300000X
TX24666122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist