Provider Demographics
NPI:1881030872
Name:HUSSEIN, THAYER F (DDS)
Entity Type:Individual
Prefix:DR
First Name:THAYER
Middle Name:F
Last Name:HUSSEIN
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 1:13872 HARBOR BLVD STE 1A-3
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4041
Mailing Address - Country:US
Mailing Address - Phone:714-265-1000
Mailing Address - Fax:714-265-1001
Practice Address - Street 1:13872 HARBOR BLVD STE 1A-3
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4041
Practice Address - Country:US
Practice Address - Phone:714-265-1000
Practice Address - Fax:714-265-1001
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA640431223G0001X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program