Provider Demographics
NPI:1023160041
Name:KINAIA, BASSAM (DDS)
Entity type:Individual
Prefix:DR
First Name:BASSAM
Middle Name:
Last Name:KINAIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 METROPOLITAN PKWY
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3710
Mailing Address - Country:US
Mailing Address - Phone:586-275-7667
Mailing Address - Fax:586-275-7872
Practice Address - Street 1:3801 METROPOLITAN PKWY
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3710
Practice Address - Country:US
Practice Address - Phone:586-275-7667
Practice Address - Fax:586-275-7872
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI176761223G0001X
MI29010176761223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI463306091Other01
MI4469514Medicaid