Provider Demographics
NPI:1750098224
Name:EASTSIDE IMPLANTS & PERIODONTICS
Entity type:Organization
Organization Name:EASTSIDE IMPLANTS & PERIODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALEED
Authorized Official - Middle Name:
Authorized Official - Last Name:RHEBI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-757-5454
Mailing Address - Street 1:25523 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1824
Mailing Address - Country:US
Mailing Address - Phone:586-757-5454
Mailing Address - Fax:586-757-4147
Practice Address - Street 1:25523 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1824
Practice Address - Country:US
Practice Address - Phone:586-757-5454
Practice Address - Fax:586-757-4147
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHIGAN IMPLANTS & PERIODONTICS INSTITUTE, P.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1447709662OtherNPI