Ghanem M. Ghannam, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

014082 Issued in MI

Practice address

5705 W Vernor Hwy
Detroit, MI 48209-2157

Phone

(313) 842-3770

NPI assigned

Mar 5, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• G Ghannam D D S

  • Dental Clinic/Center
  • Detroit, MI
  • NPI 1255508800

  General Practice

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1770612780",
    "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": "GHANEM",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-05",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "014082",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "014082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1692476",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maya Ghandour, NP
• Rachan Ghandour, MD
• Ali Ghanem, MD, MSC
• John George Ghanem, M.D.
• Kristina Marie Ghanem
• Mousa Ghannam, DMD
• Sanjna Sanjiv Ghanshani
• Dipti Ghatol, MD
• Rachad Ghazal, MD
• Petra Gheraibeh, MD

• Oral and Maxillofacial Surgery (Dentist) in Detroit, MI
• Providers in Detroit, MI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.