Healthcare Provider Details

I. General information

NPI: 1083459135
Provider Name (Legal Business Name): DALEEN SIHEIM HAMMOUD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2024
Last Update Date: 06/29/2024
Certification Date: 06/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2064 BALDWIN ST STE A
JENISON MI
49428-8773
US

IV. Provider business mailing address

5047 CHERRY BLOSSOM CIR
WEST BLOOMFIELD MI
48324-4009
US

V. Phone/Fax

Practice location:
  • Phone: 616-457-2299
  • Fax:
Mailing address:
  • Phone: 313-693-8966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901602223
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: