Provider Demographics
NPI:1760167589
Name:PARK DENTAL PLC
Entity Type:Organization
Organization Name:PARK DENTAL PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GHADA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYDOUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-671-9353
Mailing Address - Street 1:17843 PARKSHORE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8579
Mailing Address - Country:US
Mailing Address - Phone:313-671-9353
Mailing Address - Fax:
Practice Address - Street 1:1880 EMMONS BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-3866
Practice Address - Country:US
Practice Address - Phone:313-388-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty