Provider Demographics
NPI:1568587020
Name:ELZEIN, HOSSNI I (DDS)
Entity Type:Individual
Prefix:MR
First Name:HOSSNI
Middle Name:I
Last Name:ELZEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:CENTERLINE
Other - Middle Name:DENTURE
Other - Last Name:CLINIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:24625 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-2303
Mailing Address - Country:US
Mailing Address - Phone:586-756-5880
Mailing Address - Fax:
Practice Address - Street 1:24625 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-2303
Practice Address - Country:US
Practice Address - Phone:586-756-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018450122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4739066Medicaid