Healthcare Provider Details

I. General information

NPI: 1710834841
Provider Name (Legal Business Name): HASSAN MAHMOUD ABBOUD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2429 ELLSWORTH RD
YPSILANTI MI
48197-4853
US

IV. Provider business mailing address

7005 JONATHON ST
DEARBORN MI
48126-1845
US

V. Phone/Fax

Practice location:
  • Phone: 734-434-0043
  • Fax:
Mailing address:
  • Phone: 313-400-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901602964
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: