Healthcare Provider Details

I. General information

NPI: 1699453472
Provider Name (Legal Business Name): ADAM ASSEM HOUSSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7640 SYLVANIA AVE STE D
SYLVANIA OH
43560-9263
US

IV. Provider business mailing address

2045 W CENTRAL AVE APT 225
TOLEDO OH
43606-3916
US

V. Phone/Fax

Practice location:
  • Phone: 419-318-5410
  • Fax:
Mailing address:
  • Phone: 567-313-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRES.004993
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: