Rayan M Al Edreesi, BDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

2952000770 Issued in MI

Practice address

2700 Martin Luther King Jr Blvd
Detroit, MI 48208-2576

Phone

(313) 494-6700

NPI assigned

Mar 28, 2017

Last updated

Sep 27, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1528590783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 MARTIN LUTHER KING JR BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482082576",
            "telephone_number": "313-494-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 MARTIN LUTHER KING JR BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482082576",
            "telephone_number": "313-494-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AL EDREESI",
        "first_name": "RAYAN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "BDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-28",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MA",
            "license": "DL13096",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MI",
            "license": "2952000770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shada Al Anani, MD
• Rola Bassam Al Assi
• Balsam Al Balaghi, P.A.
• Randa Al Barazi, MD
• Fadi Khalil Al Daoud, M.D
• Mona Abdullah Al Fares, M.D.
• Farah Mohammed Al Haj, M.D.
• Mohammed Najeeb Al Hallak, M.D.
• Ruyof Khaled Al Hussein
• Maria Al Ismail

• Periodontics in Detroit, MI
• Providers in Detroit, MI by specialty
• Periodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.