| G Ghannam D D S | |
|
5705 W Vernor Hwy Detroit MI 48209-2157 | |
| (313) 842-3770 | |
| Not Available |
| Full Name | G Ghannam D D S |
|---|---|
| Speciality | Clinic/Center |
| Location | 5705 W Vernor Hwy, Detroit, Michigan |
| Authorized Official Name and Position | Ghanem M. Ghannam (SOLE OWNER) |
| Authorized Official Contact | 3138423770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| G Ghannam D D S 5705 W Vernor Hwy Detroit MI 48209-2157 Ph: (313) 842-3770 | G Ghannam D D S 5705 W Vernor Hwy Detroit MI 48209-2157 Ph: (313) 842-3770 |
| NPI Number | 1255508800 |
|---|---|
| Provider Enumeration Date | 05/13/2008 |
| Last Update Date | 08/29/2024 |
| Medicare PECOS PAC ID | 0547700908 |
|---|---|
| Medicare Enrollment ID | O20240911004462 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255508800 | NPI | - | NPPES |
| 1692476 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Ghanem Ghannam |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1770612780 PECOS PAC ID: 9436451846 Enrollment ID: I20240911004511 |
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