Provider Demographics
NPI:1710081005
Name:DR BEYDOUN AND ASSOCIATES, INC
Entity Type:Organization
Organization Name:DR BEYDOUN AND ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEYDOUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-561-2100
Mailing Address - Street 1:24510 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3110
Mailing Address - Country:US
Mailing Address - Phone:313-561-2100
Mailing Address - Fax:313-561-1170
Practice Address - Street 1:24510 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3110
Practice Address - Country:US
Practice Address - Phone:313-561-2100
Practice Address - Fax:313-561-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI163621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4620292Medicaid