Provider Demographics
NPI:1972611028
Name:BEYDOUN, AHMAD A (DDS)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:A
Last Name:BEYDOUN
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 1:10033 VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1513
Mailing Address - Country:US
Mailing Address - Phone:313-843-6530
Mailing Address - Fax:313-843-1410
Practice Address - Street 1:10033 VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1513
Practice Address - Country:US
Practice Address - Phone:313-843-6530
Practice Address - Fax:313-843-1410
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29-01-016362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4881109Medicaid