Provider Demographics
NPI:1124850292
Name:MAMOON, SHEIKH MUHAMMAD (DMD)
Entity type:Individual
Prefix:DR
First Name:SHEIKH
Middle Name:MUHAMMAD
Last Name:MAMOON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1687 EMERALD PINES DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2236
Mailing Address - Country:US
Mailing Address - Phone:734-331-5027
Mailing Address - Fax:
Practice Address - Street 1:348 WILSON AVE NW
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49534-3555
Practice Address - Country:US
Practice Address - Phone:616-317-2485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-17
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016023121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice