Healthcare Provider Details

I. General information

NPI: 1114221322
Provider Name (Legal Business Name): HUSSAIN ARBAB BDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13403 E 13 MILE RD
WARREN MI
48088-3196
US

IV. Provider business mailing address

13403 E 13 MILE RD
WARREN MI
48088-3196
US

V. Phone/Fax

Practice location:
  • Phone: 586-979-2800
  • Fax:
Mailing address:
  • Phone: 586-979-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number5315075676
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: