Provider Demographics
NPI:1164045357
Name:YOUSSEF, MOHAMED ATEF (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:ATEF
Last Name:YOUSSEF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 RUE BERLIOZ
Mailing Address - Street 2:
Mailing Address - City:VERDUN
Mailing Address - State:QC
Mailing Address - Zip Code:H3E1M1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:247 BOULEVARD ST-LUC, SUITE 201
Practice Address - Street 2:
Practice Address - City:SAINT JEAN SUR RICHELIEU
Practice Address - State:QUEBEC
Practice Address - Zip Code:J2W 0J3
Practice Address - Country:CA
Practice Address - Phone:450-349-0410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.01339361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice