Basic Information
| Provider Information | |||||||||
| NPI: | 1003012857 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUSSAINY | ||||||||
| FirstName: | MIRWAIS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2607 MOUNDGLEN LN | ||||||||
| Address2: | |||||||||
| City: | SPRING VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919776737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109201444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 MACARTHUR PL STE 700 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927077705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147085361 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | 52401 | CA | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.