Provider Demographics
NPI:1942295209
Name:HOUSSEIN, AMMAR ISMAIL (DDS)
Entity Type:Individual
Prefix:
First Name:AMMAR
Middle Name:ISMAIL
Last Name:HOUSSEIN
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 1:8856 KATHRYN DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-9786
Mailing Address - Country:US
Mailing Address - Phone:989-831-5237
Mailing Address - Fax:989-831-5522
Practice Address - Street 1:620 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888-9239
Practice Address - Country:US
Practice Address - Phone:989-831-5237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010178411223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901017841OtherHOUSSEIN LICENSE
MI4552639Medicaid