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General NPI Number Information
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NPI Number | 1104329473
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Entity Type | Individual
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Provider Name | ANDREW THOMAS DAABOUS DDS
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Gender | Male
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 20392 EUREKA RD
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City | TAYLOR
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State | MI
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Zip | 48180-5310
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Country | US
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Telephone | 734-284-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 MARTIN LUTHER KING JR BLVD
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City | DETROIT
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State | MI
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Zip | 48208-2576
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Country | US
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Telephone | 313-494-6606
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2901600696
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License Number State | MI
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