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General NPI Number Information
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NPI Number | 1225926363
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Entity Type | Individual
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Provider Name | MOHAMED ALI HUSSEIN DMD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 49175 PONTIAC TRL
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City | WIXOM
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State | MI
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Zip | 48393-2580
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Country | US
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Telephone | 248-859-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 21710 BEECHCREST ST
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-2405
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Country | US
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Telephone | 313-286-1888
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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 | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 2901602675
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License Number State | MI
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