Provider Demographics
NPI:1700484375
Name:TROY COSMETIC AND IMPLANT DENTAL CENTER PLLC
Entity Type:Organization
Organization Name:TROY COSMETIC AND IMPLANT DENTAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ESSAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:248-528-3518
Mailing Address - Street 1:4770 ROCHESTER RD STE 106
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4951
Mailing Address - Country:US
Mailing Address - Phone:248-528-3518
Mailing Address - Fax:
Practice Address - Street 1:4770 ROCHESTER RD STE 106
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-4951
Practice Address - Country:US
Practice Address - Phone:248-528-3518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1073997441Medicaid