Provider Demographics
NPI:1972838977
Name:DR. YOUSSEF & ASSOCIATES, PA
Entity Type:Organization
Organization Name:DR. YOUSSEF & ASSOCIATES, PA
Other - Org Name:DENTALWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-524-0099
Mailing Address - Street 1:17300 DALLAS PARKWAY
Mailing Address - Street 2:#1070
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248
Mailing Address - Country:US
Mailing Address - Phone:972-755-0880
Mailing Address - Fax:972-755-0890
Practice Address - Street 1:1595 GLIDEWELL DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215
Practice Address - Country:US
Practice Address - Phone:336-524-0099
Practice Address - Fax:216-584-1124
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTALONE PARTNERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-08
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8500122300000X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty