Provider Demographics
NPI:1295163350
Name:YUSAF, AMBREEN (DDS)
Entity type:Individual
Prefix:DR
First Name:AMBREEN
Middle Name:
Last Name:YUSAF
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20690 MAPLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7942
Mailing Address - Country:US
Mailing Address - Phone:734-560-1907
Mailing Address - Fax:
Practice Address - Street 1:5601 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-3810
Practice Address - Country:US
Practice Address - Phone:517-882-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021074122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist