Healthcare Provider Details

I. General information

NPI: 1083551758
Provider Name (Legal Business Name): AHMAD FAWAZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4291 STATE ST
SAGINAW MI
48603-4051
US

IV. Provider business mailing address

8275 APPLETON ST
DEARBORN HEIGHTS MI
48127-1403
US

V. Phone/Fax

Practice location:
  • Phone: 989-793-0899
  • Fax:
Mailing address:
  • Phone: 313-213-1831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5315264114
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: