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Organization
G GHANNAM D D S
Active
Organization
G GHANNAM D D S
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GHANEM M. GHANNAM DDS (SOLE OWNER)
(313) 842-3770
Entity
Organization
Contact information
Practice address
5705 W VERNOR HWY, DETROIT, MI 48209-2157
(313) 842-3770
Mailing address
5705 W VERNOR HWY, DETROIT, MI 48209-2157
(313) 842-3770
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1692476
—
MI
Enumeration date
05/13/2008
Last updated
09/04/2026
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