Healthcare Provider Details

I. General information

NPI: 1952125494
Provider Name (Legal Business Name): NORTH BRANCH DENTAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 HURON ST
NORTH BRANCH MI
48461-8152
US

IV. Provider business mailing address

3720 HURON ST
NORTH BRANCH MI
48461-8152
US

V. Phone/Fax

Practice location:
  • Phone: 810-688-3008
  • Fax:
Mailing address:
  • Phone: 810-688-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NOOR YOUSIF
Title or Position: OWNER/PROVIDER
Credential: DDS
Phone: 810-688-3008