MEDICARE: AMIRA HASSAN SIDAHMED-BAKRI III

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	124Q00000X	Dental Hygienist

General Provider Information

NPI Number	:	1972456713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIRA HASSAN SIDAHMED-BAKRI III

Provider Business Mailing Address
First Line	:	8243 PINE HOLLOW TRL
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-7434
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8243 PINE HOLLOW TRL
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-7434
Country	:	US
Telephone Number	:	703-217-9475
Fax Number	:

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

Provider Enumeration Date	:	02/20/2026
Last Update Date	:	02/20/2026

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