Provider Demographics
NPI:1841049236
Name:YASIN, MAMDOUH HUSAM (DMD)
Entity type:Individual
Prefix:
First Name:MAMDOUH
Middle Name:HUSAM
Last Name:YASIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 LEAFY PASS
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-5036
Mailing Address - Country:US
Mailing Address - Phone:479-806-4111
Mailing Address - Fax:
Practice Address - Street 1:3206 ELMHURST DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9616
Practice Address - Country:US
Practice Address - Phone:501-226-6941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist