Provider Demographics
NPI:1871855841
Name:HAMMOUD, OMRAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:OMRAN
Middle Name:
Last Name:HAMMOUD
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 1:5777 W MAPLE RD STE 160
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4448
Mailing Address - Country:US
Mailing Address - Phone:248-851-2980
Mailing Address - Fax:
Practice Address - Street 1:5777 W MAPLE RD STE 160
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4448
Practice Address - Country:US
Practice Address - Phone:248-851-2980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010206461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice