Individual
DR. GHANEM M. GHANNAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
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
014082
MI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
014082
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1692476
—
MI
Enumeration date
03/05/2007
Last updated
08/08/2024
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