Provider Demographics
NPI:1952919631
Name:ISRAEL, REEM RIADH (DDS)
Entity Type:Individual
Prefix:
First Name:REEM
Middle Name:RIADH
Last Name:ISRAEL
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 1:27312 HAMPDEN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3114
Mailing Address - Country:US
Mailing Address - Phone:248-631-9841
Mailing Address - Fax:
Practice Address - Street 1:2645 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1554
Practice Address - Country:US
Practice Address - Phone:248-541-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist