Provider Demographics
NPI:1932260791
Name:ZETOUNA, MAHA (DDS)
Entity Type:Individual
Prefix:
First Name:MAHA
Middle Name:
Last Name:ZETOUNA
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 1:8012 SHELDON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1800
Mailing Address - Country:US
Mailing Address - Phone:734-354-9500
Mailing Address - Fax:734-354-9502
Practice Address - Street 1:8012 SHELDON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1800
Practice Address - Country:US
Practice Address - Phone:734-354-9500
Practice Address - Fax:734-354-9502
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI169081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4976605Medicaid
MI4911950Medicaid
MID801039OtherBCBS