MEDICARE: DR BEYDOUN AND ASSOCIATES, INC

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	1223G0001X	General Practice Dentistry	16362	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710081005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR BEYDOUN AND ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	24510 FORD RD
Second Line	:
City	:	DEARBORN HTS
State	:	MI
Zip	:	48127-3110
Country	:	US
Telephone Number	:	313-561-2100
Fax Number	:	313-561-1170

Provider Business Practice Location Address
First Line	:	24510 FORD RD
Second Line	:
City	:	DEARBORN HTS
State	:	MI
Zip	:	48127-3110
Country	:	US
Telephone Number	:	313-561-2100
Fax Number	:	313-561-1170

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. AHMAD A BEYDOUN
Credential	:	DDS
Telephone Number	:	313-561-2100

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	08/22/2020

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