Provider Demographics
NPI:1649965872
Name:MUSSA, MOHAMED HUSSAIN (DDS)
Entity type:Individual
Prefix:
First Name:MOHAMED HUSSAIN
Middle Name:
Last Name:MUSSA
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 1:139 W LAKE LANSING RD STE 200
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8525
Mailing Address - Country:US
Mailing Address - Phone:517-332-8665
Mailing Address - Fax:
Practice Address - Street 1:139 W LAKE LANSING RD STE 200
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8525
Practice Address - Country:US
Practice Address - Phone:517-332-8665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist