Provider Demographics
NPI:1629585179
Name:DIAMOND FAMILY DENTAL
Entity Type:Organization
Organization Name:DIAMOND FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:SALWAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:YOUSIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-983-8333
Mailing Address - Street 1:39042 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-1701
Mailing Address - Country:US
Mailing Address - Phone:586-983-8333
Mailing Address - Fax:586-983-8337
Practice Address - Street 1:39042 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-1701
Practice Address - Country:US
Practice Address - Phone:586-983-8333
Practice Address - Fax:586-983-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2018-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty