Healthcare Provider Details

I. General information

NPI: 1992692768
Provider Name (Legal Business Name): MOHAMMAD DAOUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7125 ORCHARD LAKE RD STE 310
WEST BLOOMFIELD MI
48322-3620
US

IV. Provider business mailing address

5877 TABOR DR
WEST BLOOMFIELD MI
48322-1819
US

V. Phone/Fax

Practice location:
  • Phone: 734-812-5112
  • Fax:
Mailing address:
  • Phone: 386-316-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901602665
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: