Healthcare Provider Details

I. General information

NPI: 1699845966
Provider Name (Legal Business Name): SADEER OSAM DAOOD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23239 MICHIGAN AVE
DEARBORN MI
48124-2029
US

IV. Provider business mailing address

PO BOX 2421
DEARBORN MI
48123-2421
US

V. Phone/Fax

Practice location:
  • Phone: 313-561-6500
  • Fax:
Mailing address:
  • Phone: 519-919-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901019131
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: