Mousa Ghannam, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901602771 Issued in MI

Practice address

5705 W Vernor Hwy
Detroit, MI 48209-2157

Phone

(313) 842-3770

NPI assigned

Jun 17, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776297600000",
    "number": "1407699440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5705 W VERNOR HWY",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482092157",
            "telephone_number": "313-842-3770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5705 W VERNOR HWY",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482092157",
            "telephone_number": "313-842-3770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHANNAM",
        "first_name": "MOUSA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-17",
        "last_updated": "2026-04-16",
        "certification_date": "2026-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901602771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachan Ghandour, MD
• Ali Ghanem, MD, MSC
• John George Ghanem, M.D.
• Kristina Marie Ghanem
• Ghanem M. Ghannam, D.D.S.
• Sanjna Sanjiv Ghanshani
• Dipti Ghatol, MD
• Rachad Ghazal, MD
• Petra Gheraibeh, MD
• Jennifer C Gherasim, CRNA

• General Practice Dentistry in Detroit, MI
• Providers in Detroit, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.