Provider Demographics
NPI:1740561182
Name:AZZO, RANA ADNAN (DDS)
Entity type:Individual
Prefix:DR
First Name:RANA
Middle Name:ADNAN
Last Name:AZZO
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 1:4940 W POND CIR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2278
Mailing Address - Country:US
Mailing Address - Phone:248-974-7405
Mailing Address - Fax:
Practice Address - Street 1:2083 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4804
Practice Address - Country:US
Practice Address - Phone:586-275-2021
Practice Address - Fax:586-983-9511
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010205371223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty