Provider Demographics
NPI:1154433522
Name:DR AHMAD A. BEYDOUN DDS , PC
Entity type:Organization
Organization Name:DR AHMAD A. BEYDOUN DDS , PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEYDOUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-843-6530
Mailing Address - Street 1:10033 VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1513
Mailing Address - Country:US
Mailing Address - Phone:313-843-6530
Mailing Address - Fax:313-843-1410
Practice Address - Street 1:10033 VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1513
Practice Address - Country:US
Practice Address - Phone:313-843-6530
Practice Address - Fax:313-843-1410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI163621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4881109Medicaid