Provider Demographics
NPI:1134261571
Name:MALOUF, WISSAM BENDOC (DDS)
Entity type:Individual
Prefix:DR
First Name:WISSAM
Middle Name:BENDOC
Last Name:MALOUF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SAM
Other - Middle Name:BENDOC
Other - Last Name:MALOUF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:27600 LITTLE MACK
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081
Mailing Address - Country:US
Mailing Address - Phone:586-772-9020
Mailing Address - Fax:586-222-0709
Practice Address - Street 1:27600 LITTLE MACK
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081
Practice Address - Country:US
Practice Address - Phone:586-772-9020
Practice Address - Fax:586-222-0709
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist