Provider Demographics
NPI:1053320622
Name:AL-QAWASMI, RIYAD A (BDS, MSD, PHD)
Entity Type:Individual
Prefix:
First Name:RIYAD
Middle Name:A
Last Name:AL-QAWASMI
Suffix:
Gender:M
Credentials:BDS, MSD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42515 ADAMS CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2376
Mailing Address - Country:US
Mailing Address - Phone:734-414-0345
Mailing Address - Fax:
Practice Address - Street 1:4227 OLD CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188
Practice Address - Country:US
Practice Address - Phone:734-397-6999
Practice Address - Fax:734-397-6888
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010190341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics