Provider Demographics
NPI:1093238966
Name:GAGI, YOUSIF
Entity Type:Individual
Prefix:
First Name:YOUSIF
Middle Name:
Last Name:GAGI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 JOHN R RD APT 104
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2582
Mailing Address - Country:US
Mailing Address - Phone:586-480-8996
Mailing Address - Fax:
Practice Address - Street 1:525 E BIG BEAVER RD STE 110
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1365
Practice Address - Country:US
Practice Address - Phone:248-362-4330
Practice Address - Fax:248-362-4033
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022355122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist