MEDICARE: BIRMINGHAM DENTISTRY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1154935393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIRMINGHAM DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	11250 E 13 MILE RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48093-2597
Country	:	US
Telephone Number	:	586-574-9500
Fax Number	:

Provider Business Practice Location Address
First Line	:	751 CHESTNUT ST
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-6461
Country	:	US
Telephone Number	:	248-644-8520
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMED SAAD
Credential	:	DDS
Telephone Number	:	313-461-5282

Provider Enumeration Date	:	09/04/2020
Last Update Date	:	09/04/2020

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