MEDICARE: NADER J BAYDOUN DDS

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	122300000X	Dentist	50441	CA
2	1223G0001X	General Practice Dentistry	2901019741	MI
3	122300000X	Dentist	2901019741	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1255577409	OTHER	MI	NPPES

General Provider Information

NPI Number	:	1255577409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADER J BAYDOUN DDS

Provider Business Mailing Address
First Line	:	24510 FORD RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3110
Country	:	US
Telephone Number	:	313-561-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	6950 SCHAEFER RD STE A
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-4503
Country	:	US
Telephone Number	:	313-584-3210
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2008
Last Update Date	:	04/23/2019

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