Provider Demographics
NPI:1235023060
Name:DAWOUD, TYSER
Entity type:Individual
Prefix:
First Name:TYSER
Middle Name:
Last Name:DAWOUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23126 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1373
Mailing Address - Country:US
Mailing Address - Phone:313-671-6319
Mailing Address - Fax:
Practice Address - Street 1:23126 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1373
Practice Address - Country:US
Practice Address - Phone:313-671-6319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016026591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice