Provider Demographics
NPI:1982444998
Name:YAZBEK, OUSSAMA
Entity type:Individual
Prefix:
First Name:OUSSAMA
Middle Name:
Last Name:YAZBEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3644 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3579
Mailing Address - Country:US
Mailing Address - Phone:313-695-3696
Mailing Address - Fax:
Practice Address - Street 1:6755 MERRIMAN RD UNIT 1
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-1978
Practice Address - Country:US
Practice Address - Phone:734-884-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901602170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist