Provider Demographics
NPI:1225648017
Name:MIKHAIL, YOUSTINA MOZEIH SHAKER (BDS)
Entity Type:Individual
Prefix:
First Name:YOUSTINA
Middle Name:MOZEIH SHAKER
Last Name:MIKHAIL
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 S BROADWAY AVE APT 137
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7670
Mailing Address - Country:US
Mailing Address - Phone:951-603-4336
Mailing Address - Fax:
Practice Address - Street 1:651 CROSS TIMBERS RD STE 102
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1300
Practice Address - Country:US
Practice Address - Phone:951-603-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.0042831223G0001X
TX400411223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice