MEDICARE: DR. MAGI YOUSSEF D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	9507	NC

General Provider Information

NPI Number	:	1386080208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAGI YOUSSEF D.D.S.

Provider Business Mailing Address
First Line	:	101 SLEEPY DR
Second Line	:	#102
City	:	SPRING LAKE
State	:	NC
Zip	:	28390-3317
Country	:	US
Telephone Number	:	910-497-2969
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 SLEEPY DR
Second Line	:	#102
City	:	SPRING LAKE
State	:	NC
Zip	:	28390-3317
Country	:	US
Telephone Number	:	910-497-2969
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2013
Last Update Date	:	06/21/2014

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