Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 2901019034 | MI |
NPI | 1053320622 |
---|---|
Provider Name | Riyad A Al-Qawasmi |
First Address | Canton, MI 48187-2376 |
Second Address | Canton, MI 48188 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/07/2007 |