Provider Demographics
NPI:1962811869
Name:YOUSEF, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:YOUSEF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 OAK BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-5638
Mailing Address - Country:US
Mailing Address - Phone:951-660-1347
Mailing Address - Fax:
Practice Address - Street 1:307 OAK BRANCH DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-5638
Practice Address - Country:US
Practice Address - Phone:951-660-1347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30356122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist