Provider Demographics
NPI:1144770652
Name:MOHAMMED, ABDUL GHANI FAHD (DDS)
Entity Type:Individual
Prefix:
First Name:ABDUL GHANI FAHD
Middle Name:
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23800 ORCHARD LAKE RD
Mailing Address - Street 2:STE. 106
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2560
Mailing Address - Country:US
Mailing Address - Phone:248-755-5700
Mailing Address - Fax:
Practice Address - Street 1:12871 E JEFFERSON AVE
Practice Address - Street 2:STE. C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2754
Practice Address - Country:US
Practice Address - Phone:313-822-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist