Provider Demographics
NPI:1922185982
Name:HAOUILOU, ODETTE ROYE (DDS)
Entity Type:Individual
Prefix:
First Name:ODETTE
Middle Name:ROYE
Last Name:HAOUILOU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18000 VERNIER
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225
Mailing Address - Country:US
Mailing Address - Phone:313-521-2070
Mailing Address - Fax:313-526-9907
Practice Address - Street 1:12807 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1532
Practice Address - Country:US
Practice Address - Phone:313-582-1400
Practice Address - Fax:313-526-9907
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17494122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4478059Medicaid