Healthcare Provider Details

I. General information

NPI: 1164333936
Provider Name (Legal Business Name): JACOB KAWWAS DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6024 W MAPLE RD STE 105
WEST BLOOMFIELD MI
48322-4405
US

IV. Provider business mailing address

1539 COLE ST
BIRMINGHAM MI
48009-7063
US

V. Phone/Fax

Practice location:
  • Phone: 248-974-4574
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JACOB KAWWAS
Title or Position: DENTIST
Credential: DDS
Phone: 248-974-4574