Provider Demographics
NPI:1609846898
Name:ALSOUSS, ADIB M (DDS)
Entity type:Individual
Prefix:
First Name:ADIB
Middle Name:M
Last Name:ALSOUSS
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 1:1924 SNOW RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-2725
Mailing Address - Country:US
Mailing Address - Phone:216-351-2152
Mailing Address - Fax:216-351-2332
Practice Address - Street 1:1924 SNOW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-2725
Practice Address - Country:US
Practice Address - Phone:216-351-2152
Practice Address - Fax:216-351-2332
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH209211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice