Provider Demographics
NPI:1588776975
Name:ALABBOUSI, REEM (DDS)
Entity type:Individual
Prefix:DR
First Name:REEM
Middle Name:
Last Name:ALABBOUSI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:REEM
Other - Middle Name:
Other - Last Name:ALABBOUSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:25711 W WARREN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2046
Mailing Address - Country:US
Mailing Address - Phone:313-565-1862
Mailing Address - Fax:313-562-5428
Practice Address - Street 1:25711 W WARREN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2046
Practice Address - Country:US
Practice Address - Phone:313-565-1862
Practice Address - Fax:313-562-5428
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH182881223G0001X
MI29010182881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4620130Medicaid