Provider Demographics
NPI:1437828399
Name:ELLAUZI, ASIL (BDS MS)
Entity Type:Individual
Prefix:DR
First Name:ASIL
Middle Name:
Last Name:ELLAUZI
Suffix:
Gender:F
Credentials:BDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6746 WOODLAND HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3376
Mailing Address - Country:US
Mailing Address - Phone:734-707-6486
Mailing Address - Fax:
Practice Address - Street 1:1515 E US HIGHWAY 223 STE G
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-4456
Practice Address - Country:US
Practice Address - Phone:517-264-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601107122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist