Provider Demographics
NPI:1912523010
Name:BOLUS, YOUSIF (DMD)
Entity Type:Individual
Prefix:
First Name:YOUSIF
Middle Name:
Last Name:BOLUS
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 1:43264 WINTERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1865
Mailing Address - Country:US
Mailing Address - Phone:586-839-9311
Mailing Address - Fax:
Practice Address - Street 1:4311 W ADAMS AVE STE 201
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-3407
Practice Address - Country:US
Practice Address - Phone:254-231-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36191122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist