Provider Demographics
NPI:1174064273
Name:RITA R MARROGHI DDS,P.C
Entity type:Organization
Organization Name:RITA R MARROGHI DDS,P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARROGHI-JABRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-790-9600
Mailing Address - Street 1:683 W HURON ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1522
Mailing Address - Country:US
Mailing Address - Phone:248-335-1000
Mailing Address - Fax:
Practice Address - Street 1:683 W HURON ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1522
Practice Address - Country:US
Practice Address - Phone:248-335-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016756122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1386714632Medicaid