Healthcare Provider Details

I. General information

NPI: 1164773024
Provider Name (Legal Business Name): CHILDREN'S DENTAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14710 W WARREN AVE
DEARBORN MI
48126-1347
US

IV. Provider business mailing address

14710 W WARREN AVE
DEARBORN MI
48126-1347
US

V. Phone/Fax

Practice location:
  • Phone: 313-404-1061
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2901019369
License Number StateMI

VIII. Authorized Official

Name: DR. HASSAN SAMI OUEIS
Title or Position: MEMBER
Credential: D.D.S
Phone: 313-404-1061