Provider Demographics
NPI:1982434288
Name:MOUSA-AQRAWI, FADI (DDS)
Entity type:Individual
Prefix:
First Name:FADI
Middle Name:
Last Name:MOUSA-AQRAWI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4777 ASPENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-2945
Mailing Address - Country:US
Mailing Address - Phone:586-636-5080
Mailing Address - Fax:
Practice Address - Street 1:31207 RYAN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-3761
Practice Address - Country:US
Practice Address - Phone:586-553-9399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016023371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice