Provider Demographics
NPI:1962998971
Name:YOUSSEF, MOHAMED ALY IBRAHIM (DMD)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ALY IBRAHIM
Last Name:YOUSSEF
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 1:20722 ROMAGNA PL
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-3276
Mailing Address - Country:US
Mailing Address - Phone:941-303-0690
Mailing Address - Fax:
Practice Address - Street 1:3652 COOLIDGE CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-7890
Practice Address - Country:US
Practice Address - Phone:850-222-0049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist