Provider Demographics
NPI:1114210002
Name:DEEBAJAH, AHMAD
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:
Last Name:DEEBAJAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 JOHN R RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3144 JOHN R RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5936
Practice Address - Country:US
Practice Address - Phone:248-510-1100
Practice Address - Fax:248-251-0073
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020359122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist