Individual
MR. NIZAR NAUM MANSOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
28437 GREENFIELD RD, SUITE 101, SOUTHFIELD, MI 48076
(248) 557-5461
(248) 559-3163
Mailing address
28437 GREENFIELD RD, SUITE 101, SOUTHFIELD, MI 48076
(248) 557-5461
(248) 559-3163
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901012608
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12608
BLUE CROSS
—
05
—
4065433
—
MI
05
—
4074460
—
MI
Enumeration date
12/01/2006
Last updated
07/08/2007
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