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NPI Code Detail

MEDICARE: REEM MAHJOUB DMD

MEDICARE: REEM MAHJOUB DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry1001476-15WI

General Provider Information

NPI Number : 1477908648
Entity Type Code : Individual
Provider Name (Legal Business Name) : REEM MAHJOUB DMD
Provider Business Mailing Address
First Line : 6828 WANDAWEGA CIR
Second Line :
City : MEQUON
State : WI
Zip : 53092-8514
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1300 W LINCOLN AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-3127
Country : US
Telephone Number : 414-377-3808
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2016
Last Update Date : 04/27/2018

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