Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901019855 | MI |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 2901019855 | MI |
NPI | 1033362793 |
---|---|
Provider Name | Dr. Alvin Yousif Daboul |
First Address | Royal Oak, MI 48073-3553 |
Second Address | Royal Oak, MI 48073-3553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 18/08/2021 |