MEDICARE: DR. AMMAR TAIMISH D.D.S.

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	2901018571	MI

General Provider Information

NPI Number	:	1437278777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMMAR TAIMISH D.D.S.

Provider Business Mailing Address
First Line	:	4790 MADDIE LN
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-4174
Country	:	US
Telephone Number	:	313-674-0426
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 N SHELDON RD
Second Line	:
City	:	PLYMOUTH
State	:	MI
Zip	:	48170-1524
Country	:	US
Telephone Number	:	734-453-4150
Fax Number	:

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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