Provider Demographics
NPI:1497299614
Name:YOUSSEF, MINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:
Last Name:YOUSSEF
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 1:1012 TANNERS POINT DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8159
Mailing Address - Country:US
Mailing Address - Phone:404-918-5325
Mailing Address - Fax:
Practice Address - Street 1:4145 LAWRENCEVILLE HWY NW
Practice Address - Street 2:SUITE 15
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2807
Practice Address - Country:US
Practice Address - Phone:404-918-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015327122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist