Provider Demographics
NPI:1720205651
Name:BEYDOUN, GHADA AHMAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GHADA
Middle Name:AHMAD
Last Name:BEYDOUN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22277 LONG BLVD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1146
Mailing Address - Country:US
Mailing Address - Phone:313-671-9353
Mailing Address - Fax:
Practice Address - Street 1:22701 ANN ARBOR TRL
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2574
Practice Address - Country:US
Practice Address - Phone:313-274-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI193631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice