Provider Demographics
NPI:1114032489
Name:MOUSSAED, EMILE K (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMILE
Middle Name:K
Last Name:MOUSSAED
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 ELMSMERE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1065
Mailing Address - Country:US
Mailing Address - Phone:248-449-8833
Mailing Address - Fax:
Practice Address - Street 1:1297 SHREVEPORT BARKSDALE HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2405
Practice Address - Country:US
Practice Address - Phone:318-865-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38451223G0001X
OK63571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3845OtherDENTAL LICENSE
WI33501200Medicaid
MI2901014893OtherDENTAL LICENSE