Provider Demographics
NPI:1053802629
Name:DAHER, HUSSEIN (DDS)
Entity type:Individual
Prefix:DR
First Name:HUSSEIN
Middle Name:
Last Name:DAHER
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 1:26318 SIMS ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-4123
Mailing Address - Country:US
Mailing Address - Phone:313-443-9737
Mailing Address - Fax:
Practice Address - Street 1:6061 W VERNOR HWY STE 1
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2085
Practice Address - Country:US
Practice Address - Phone:313-841-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-19
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010225981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI122300000XMedicaid