G GHANNAM D D S – NPI #1255508800
Clinic/Center

G GHANNAM D D S is an AHC clinic located in DETROIT, MI. NPPES has assigned the NPI number 1255508800 to G GHANNAM D D S on May 13, 2008. It is a Type-2 NPI, indicating this NPI number is associated with an organization. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 261QD0000X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Dental

The NPI profile was last updated on Aug 29, 2024. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for G GHANNAM D D S below.

NPI Profile for
G GHANNAM D D S

NPI Number
1255508800
Enumeration Date

(more than 18 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
G GHANNAM D D S
Primary location
5705 W VERNOR HWY
DETROIT, MI 48209-2157
Phone: (313) 842-3770 Fax:
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
GHANEM GHANNAM
SOLE OWNER
Phone: (313) 842-3770
Updated
Certification Date
Aug 29, 2024

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for G GHANNAM D D S

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
medicaidMI1692476
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QD0000X
- Clinic/Center / Dental (Primary)
1223G0001X
- Dentist / General Practice

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.