Provider Demographics
NPI:1750952263
Name:YOUSSEF, MINA
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:YOUSSEF
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 1:9601 CHESTER AVE RM 235D
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1666
Mailing Address - Country:US
Mailing Address - Phone:216-368-3615
Mailing Address - Fax:
Practice Address - Street 1:9601 CHESTER AVE RM 235D
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1666
Practice Address - Country:US
Practice Address - Phone:216-368-3615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601995122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist