Healthcare Provider Details

I. General information

NPI: 1356063275
Provider Name (Legal Business Name): NABILA CYRENE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23845 VAN DYKE AVE
CENTER LINE MI
48015-1300
US

IV. Provider business mailing address

PO BOX 32767
DETROIT MI
48232-0767
US

V. Phone/Fax

Practice location:
  • Phone: 586-467-0063
  • Fax: 844-494-0330
Mailing address:
  • Phone: 313-409-7856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901602379
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: