Provider Demographics
NPI:1801511670
Name:RMR DENTAL PLLC
Entity type:Organization
Organization Name:RMR DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEANNE
Authorized Official - Middle Name:MAJED
Authorized Official - Last Name:RAYYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-610-0271
Mailing Address - Street 1:25090 WOODWARD AVE APT 424
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-0996
Mailing Address - Country:US
Mailing Address - Phone:810-610-0271
Mailing Address - Fax:
Practice Address - Street 1:21969 HURON RIVER DR
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:MI
Practice Address - Zip Code:48173-1237
Practice Address - Country:US
Practice Address - Phone:734-379-9322
Practice Address - Fax:734-379-8932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1699260364Medicaid