Provider Demographics
NPI:1144456849
Name:PALLI, REKHA MADHURI (DDS)
Entity type:Individual
Prefix:DR
First Name:REKHA
Middle Name:MADHURI
Last Name:PALLI
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 1:48224 HEATHER CT
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8530
Mailing Address - Country:US
Mailing Address - Phone:734-398-0515
Mailing Address - Fax:
Practice Address - Street 1:4081 S CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2488
Practice Address - Country:US
Practice Address - Phone:734-398-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020008122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist