MEDICARE: HUSSIEN SAM BAYDOUN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901022593	MI
2	1223G0001X	General Practice Dentistry	2901022593	MI

General Provider Information

NPI Number	:	1427549096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUSSIEN SAM BAYDOUN DDS

Provider Business Mailing Address
First Line	:	1454 MASON ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2859
Country	:	US
Telephone Number	:	313-999-0123
Fax Number	:

Provider Business Practice Location Address
First Line	:	24366 GRAND RIVER AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219-3098
Country	:	US
Telephone Number	:	313-535-2273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2018
Last Update Date	:	05/19/2018

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