Healthcare Provider Details

I. General information

NPI: 1942295209
Provider Name (Legal Business Name): AMMAR ISMAIL HOUSSEIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W MAIN ST SUITE B
STANTON MI
48888-9239
US

IV. Provider business mailing address

8856 KATHRYN DR
GREENVILLE MI
48838-9786
US

V. Phone/Fax

Practice location:
  • Phone: 989-831-5237
  • Fax:
Mailing address:
  • Phone: 989-831-5237
  • Fax: 989-831-5522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2901017841
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: