Provider Demographics
NPI:1811088040
Name:YOUSSEF, HANAN G (DDS)
Entity type:Individual
Prefix:
First Name:HANAN
Middle Name:G
Last Name:YOUSSEF
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 N FOXKIRK DR
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-3620
Mailing Address - Country:US
Mailing Address - Phone:262-512-1827
Mailing Address - Fax:262-512-1827
Practice Address - Street 1:1608 23RD ST
Practice Address - Street 2:ZION BENTON CHILDRENS SERVICES
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-2345
Practice Address - Country:US
Practice Address - Phone:847-872-9227
Practice Address - Fax:847-872-9226
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist