Healthcare Provider Details

I. General information

NPI: 1245502848
Provider Name (Legal Business Name): AYMAN ELMADAWY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N JACKSON ST
JACKSON MI
49201-1266
US

IV. Provider business mailing address

42878 LEDGEVIEW DR
NOVI MI
48377-2710
US

V. Phone/Fax

Practice location:
  • Phone: 517-748-5500
  • Fax: 517-783-2728
Mailing address:
  • Phone: 810-814-7930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901020104
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: