Provider Demographics
NPI:1497897839
Name:WISSAM B MALOUF DDS PC
Entity Type:Organization
Organization Name:WISSAM B MALOUF DDS PC
Other - Org Name:MALOUF FAMILY & COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WISSAM
Authorized Official - Middle Name:BENDOC
Authorized Official - Last Name:MALOUF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-772-9020
Mailing Address - Street 1:27600 LITTLE MACK
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081
Mailing Address - Country:US
Mailing Address - Phone:586-772-9020
Mailing Address - Fax:586-222-0709
Practice Address - Street 1:27600 LITTLE MACK
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081
Practice Address - Country:US
Practice Address - Phone:586-772-9020
Practice Address - Fax:586-222-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty