Provider Demographics
NPI:1366489452
Name:BERRO, ABBAS HUSSEIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABBAS
Middle Name:HUSSEIN
Last Name:BERRO
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 1:1193 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-2450
Mailing Address - Country:US
Mailing Address - Phone:313-388-1800
Mailing Address - Fax:313-388-5527
Practice Address - Street 1:1193 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2450
Practice Address - Country:US
Practice Address - Phone:313-388-1800
Practice Address - Fax:313-388-5527
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010191291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4979625Medicaid