Provider Demographics
NPI:1942580188
Name:HAIFA MANSOUR DDS,PC
Entity Type:Organization
Organization Name:HAIFA MANSOUR DDS,PC
Other - Org Name:NEIGHBORHOOD FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAIFA
Authorized Official - Middle Name:KASHAT
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-582-8060
Mailing Address - Street 1:27753 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3477
Mailing Address - Country:US
Mailing Address - Phone:248-582-8060
Mailing Address - Fax:248-582-8062
Practice Address - Street 1:27753 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3477
Practice Address - Country:US
Practice Address - Phone:248-582-8060
Practice Address - Fax:248-582-8062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty