Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901601003 | MI |
NPI | 1003485723 |
---|---|
Provider Name | Dr. Nadine Husseini |
First Address | Dearborn Heights, MI 48127-2132 |
Second Address | Canton, MI 48187-2950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2021 |
Last Update Date | 04/08/2021 |