Provider Demographics
NPI:1043903925
Name:SOUEIDAN, MAYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAYA
Middle Name:
Last Name:SOUEIDAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MAYA
Other - Middle Name:IMAD
Other - Last Name:AWADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:450 N MILDRED ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1729
Mailing Address - Country:US
Mailing Address - Phone:313-663-0066
Mailing Address - Fax:
Practice Address - Street 1:47299 FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-3764
Practice Address - Country:US
Practice Address - Phone:734-459-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53152415611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice